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4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":85473.93,"maximum":239060.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85473.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85473.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":174247.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":137580.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":174247.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":212188.04},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85473.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85473.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85473.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85473.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173715.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":239060.07},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":192851.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85473.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":85473.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":40755.15,"maximum":113987.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":83083.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65600.47},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":83083.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101174.18},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82830.11},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113987.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91954.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":40755.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":31866.3,"maximum":89126.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64962.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51292.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64962.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79107.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64764.55},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89126.11},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71898.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":31866.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8360.41,"maximum":23383.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17043.57},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13457.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17043.57},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20754.63},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16991.57},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23383.05},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18863.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8360.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8959.52,"10th_percentile":8959.52,"90th_percentile":8959.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":27356.34,"10th_percentile":27356.34,"90th_percentile":27356.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9012.31,"10th_percentile":9012.31,"90th_percentile":9012.31,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9477.56,"10th_percentile":9477.56,"90th_percentile":9477.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16522.4,"maximum":46211.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33682.63},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26594.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33682.63},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41016.65},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33579.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46211.11},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37278.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16522.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1450.07,"10th_percentile":1450.07,"90th_percentile":1450.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18581.25,"10th_percentile":18581.25,"90th_percentile":18581.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14302.67,"maximum":40002.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29157.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23021.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29157.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35506.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29068.52},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40002.81},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32270.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14302.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14302.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":146.17,"10th_percentile":146.17,"90th_percentile":146.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11039.22,"10th_percentile":11039.22,"90th_percentile":11039.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13520.89,"10th_percentile":13520.89,"90th_percentile":13520.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13542.45,"10th_percentile":12819.29,"90th_percentile":13738.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5378.26,"maximum":15042.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5378.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5378.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10964.14},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8656.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10964.14},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13351.47},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5378.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5378.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5378.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5378.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10930.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15042.33},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12134.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5378.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5378.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6069.11,"10th_percentile":6069.11,"90th_percentile":6069.11,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9927.23,"maximum":27765.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20237.7},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15979.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20237.7},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24644.24},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20175.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27765.25},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22398.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9927.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10548.57,"10th_percentile":10548.57,"90th_percentile":10548.57,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12490.48,"maximum":34934.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25463.14},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20104.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25463.14},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31007.47},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25385.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34934.33},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28181.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12490.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12490.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":31299.61,"10th_percentile":31299.61,"90th_percentile":31299.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9689.69,"maximum":27100.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19753.44},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15596.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19753.44},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24054.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19693.17},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27100.86},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21862.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9689.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12859.6,"maximum":35966.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26215.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20699.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26215.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31923.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26135.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35966.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29014.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12859.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7221.04,"maximum":20196.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14720.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11623.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14720.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17926.14},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14675.92},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20196.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16292.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7221.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12324.76,"maximum":34470.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25125.32},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19838.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25125.32},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30596.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25048.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34470.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27807.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12324.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8408.06,"maximum":23516.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8408.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8408.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17140.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13533.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17140.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20872.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8408.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8408.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8408.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8408.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17088.42},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23516.32},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18970.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8408.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8408.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8951.71,"10th_percentile":8951.71,"90th_percentile":8951.71,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":31875.54,"maximum":89151.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64981.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51307.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64981.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79130.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64783.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89151.97},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71919.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":31875.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5725.34,"maximum":16013.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11671.7},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9215.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11671.7},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14213.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11636.08},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16013.06},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12917.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5725.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5725.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5725.06,"10th_percentile":5725.06,"90th_percentile":5725.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4478.01,"10th_percentile":4478.01,"90th_percentile":4478.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6017.45,"10th_percentile":6017.45,"90th_percentile":6523.49,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":150958.26,"maximum":422211.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":307744.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":242986.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":307744.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":374752.13},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":306805.17},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":422211.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":340600.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150958.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":150958.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":29985.11,"maximum":83864.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29985.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29985.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61127.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48264.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61127.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74437.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29985.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29985.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29985.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29985.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60941.27},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83864.67},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67654.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29985.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29985.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":37650.66,"maximum":105304.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37650.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37650.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76754.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60603.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76754.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93467.33},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37650.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37650.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37650.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37650.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76520.61},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105304.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84949.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37650.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":37650.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":24264.05,"maximum":67863.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24264.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24264.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49464.79},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39056.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49464.79},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60235.21},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24264.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24264.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24264.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24264.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49313.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67863.55},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54745.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24264.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":24264.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":23414.14,"maximum":65486.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23414.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23414.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47732.16},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37687.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47732.16},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58125.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23414.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23414.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23414.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23414.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47586.52},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65486.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52828.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23414.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":23414.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21040.65,"10th_percentile":21040.65,"90th_percentile":21040.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10859.65,"maximum":30373.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22138.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17479.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22138.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26958.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22070.97},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30373.09},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24502.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10859.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10859.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11549.97,"10th_percentile":11549.97,"90th_percentile":11549.97,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10611.05,"10th_percentile":10611.05,"90th_percentile":10611.05,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12497.59,"maximum":34954.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25477.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20116.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25477.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31025.12},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25399.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34954.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28197.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12497.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11840.42,"maximum":33116.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24137.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19058.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24137.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29393.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24064.28},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33116.2},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26715.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11840.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11840.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7198.56,"10th_percentile":7198.56,"90th_percentile":7198.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6369.7,"maximum":17815.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12985.3},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10252.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12985.3},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15812.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12945.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17815.28},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14371.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6369.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7813.48,"maximum":21853.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15928.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12576.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15928.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19396.88},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15880.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21853.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17629.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7813.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25687.91,"maximum":71845.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25687.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25687.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52367.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41347.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52367.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63769.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25687.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25687.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25687.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25687.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52207.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71845.93},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57958.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25687.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25687.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9622.83,"maximum":26913.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19617.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15489.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19617.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23888.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19557.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26913.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21711.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9622.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5460.76,"maximum":15273.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11132.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8789.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11132.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13556.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11098.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15273.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12320.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5460.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11353.95,"maximum":31755.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23146.2},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18275.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23146.2},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28186.04},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23075.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31755.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25617.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11353.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9469.92,"maximum":26486.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19305.42},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15243.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19305.42},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23508.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19246.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26486.2},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21366.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9469.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9469.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":185.24,"10th_percentile":185.24,"90th_percentile":185.24,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6470.7,"maximum":18097.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13191.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10415.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13191.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16063.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13150.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18097.74},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14599.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6470.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":21168.81,"maximum":59206.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43154.82},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34073.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43154.82},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52551.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43023.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59206.55},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47762.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":21168.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5361.19,"maximum":14994.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10929.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8629.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10929.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13309.09},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10896.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14994.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12096.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5361.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5361.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":92104.65,"maximum":257605.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":187764.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":148253.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":187764.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":228648.73},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187192.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":257605.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":207811.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":92104.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":38635.71,"maximum":108059.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78762.92},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62188.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":78762.92},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95912.69},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78522.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108059.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87172.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":38635.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":32337.12,"maximum":90442.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32337.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32337.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65922.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52050.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65922.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80276.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32337.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32337.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32337.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32337.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65721.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90442.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72960.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32337.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":32337.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11826.91,"maximum":33078.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24110.39},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19036.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24110.39},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29360.16},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24036.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33078.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26684.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11826.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11826.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15637.64,"maximum":43736.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31878.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25170.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31878.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38820.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31781.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43736.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35282.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15637.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15637.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12158.34,"maximum":34005.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12158.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12158.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24786.04},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19570.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24786.04},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30182.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12158.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12158.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12158.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12158.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24710.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34005.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27432.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12158.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12158.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4867.6,"maximum":13614.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4867.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4867.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9923.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7835.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9923.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12083.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4867.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4867.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4867.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4867.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9892.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13614.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10982.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4867.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4867.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5579.39,"10th_percentile":5579.39,"90th_percentile":5579.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7331.28,"maximum":20504.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14945.57},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11800.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14945.57},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18199.8},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14899.97},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20504.67},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16541.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7331.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4631.63,"10th_percentile":4631.63,"90th_percentile":4631.63,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":337.02,"10th_percentile":337.02,"90th_percentile":6278.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16158.25,"maximum":45192.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32940.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26008.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32940.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40112.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32839.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45192.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36457.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16158.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5663.46,"maximum":15840.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5663.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5663.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11545.55},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9116.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11545.55},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14059.47},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5663.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5663.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5663.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5663.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11510.33},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15840.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12778.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5663.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5663.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6335.99,"10th_percentile":6335.99,"90th_percentile":6335.99,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6419.49,"maximum":17954.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6419.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6419.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13086.8},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10332.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13086.8},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15936.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6419.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6419.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6419.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6419.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13046.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17954.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14484.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6419.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6419.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6183.42,"10th_percentile":6183.42,"90th_percentile":6183.42,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":141.39,"10th_percentile":141.39,"90th_percentile":141.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6561.94,"10th_percentile":6561.94,"90th_percentile":6561.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8273.64,"maximum":23140.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16866.69},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13317.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16866.69},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20539.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16815.22},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23140.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18667.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8273.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6302.85,"maximum":17628.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12849.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10145.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12849.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15646.75},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12809.81},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17628.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14220.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6302.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15059.41,"maximum":42119.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30700.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24240.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30700.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37384.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30606.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42119.32},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33977.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15059.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11119.95,"maximum":31101.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22669.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17898.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22669.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27605.16},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22600.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31101.14},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25089.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11119.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13614.21,"maximum":38077.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27753.99},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21913.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27753.99},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33797.12},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27669.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38077.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30717.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13614.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6941.53,"maximum":19414.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14151.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11173.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14151.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17232.26},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14107.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19414.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15661.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6941.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7060.41,"10th_percentile":7060.41,"90th_percentile":7563.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7175.18,"10th_percentile":7175.18,"90th_percentile":7904.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":211.52,"10th_percentile":211.52,"90th_percentile":211.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":32979.36,"maximum":92239.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32979.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32979.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":67231.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53084.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":67231.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81870.87},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32979.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32979.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32979.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32979.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67026.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92239.2},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74409.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32979.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":32979.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":42173.32,"maximum":117953.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85974.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67883.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85974.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104694.78},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85712.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117953.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95153.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":42173.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":27822.29,"maximum":77815.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27822.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27822.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56718.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44783.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56718.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69068.51},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27822.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27822.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27822.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27822.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56545.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77815.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62774.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27822.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":27822.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15156.14,"maximum":42389.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30897.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24395.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30897.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37624.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30803.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42389.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34196.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15156.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":27461.7,"maximum":76806.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27461.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27461.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55983.54},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44203.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55983.54},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68173.35},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27461.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27461.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27461.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27461.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55812.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76806.99},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61960.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27461.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":27461.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9214.59,"maximum":25772.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18784.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14832.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18784.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22875.11},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18727.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25772.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20790.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9214.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9404.78,"10th_percentile":96.73,"90th_percentile":10375.87,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10355.88,"10th_percentile":10355.88,"90th_percentile":10355.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":76.36,"10th_percentile":76.36,"90th_percentile":7661.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8533.08,"10th_percentile":233.78,"90th_percentile":10309.49,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7185.47,"maximum":20096.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14648.34},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11565.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14648.34},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17837.86},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14603.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20096.89},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16212.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7185.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7185.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5586.86,"10th_percentile":5578.38,"90th_percentile":8046.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7985.34,"10th_percentile":7985.34,"90th_percentile":7985.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":25222.96,"10th_percentile":25222.96,"90th_percentile":25222.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7865.43,"10th_percentile":7865.43,"90th_percentile":7865.43,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7769.06,"10th_percentile":7769.06,"90th_percentile":7769.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6614.29,"10th_percentile":6523.54,"90th_percentile":8060.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11410.13,"maximum":31912.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23260.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18366.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23260.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28325.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23189.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31912.74},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25744.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11410.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5994.66,"10th_percentile":5994.66,"90th_percentile":5994.66,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6797.86,"maximum":19012.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13858.14},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10942.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13858.14},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16875.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13815.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19012.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15337.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7275.8,"maximum":20349.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14832.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11711.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14832.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18062.09},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14787.22},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20349.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16416.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7275.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":962.56,"10th_percentile":962.56,"90th_percentile":962.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7144.64,"10th_percentile":7144.64,"90th_percentile":7144.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":541.5,"10th_percentile":541.5,"90th_percentile":541.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7003.27,"10th_percentile":7003.27,"90th_percentile":7003.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13774.95,"maximum":38526.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28081.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22172.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28081.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34196.14},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27995.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38526.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31079.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13774.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7716.05,"maximum":21580.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15729.97},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12419.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15729.97},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19154.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15681.97},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21580.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17409.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7716.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10619.96,"maximum":29702.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21649.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17094.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21649.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26363.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21583.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29702.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23961.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10619.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10619.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8551.02,"maximum":23916.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17432.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13763.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17432.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21227.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17378.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23916.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19293.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8551.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8551.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5250.24,"maximum":14684.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5250.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5250.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10703.16},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8450.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10703.16},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13033.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5250.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5250.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5250.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5250.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10670.5},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14684.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11845.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5250.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5250.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6031.83,"10th_percentile":6031.83,"90th_percentile":6031.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17951.24,"maximum":50207.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36595.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28894.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36595.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44563.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36483.81},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50207.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40502.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17951.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17951.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11114.26,"maximum":31085.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22657.59},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17889.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22657.59},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27591.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22588.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31085.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25076.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11114.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11114.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11245.54,"10th_percentile":11245.54,"90th_percentile":12453.0,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11565.38,"10th_percentile":11565.38,"90th_percentile":11565.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":31019.79,"10th_percentile":30109.69,"90th_percentile":60450.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":25203.8,"10th_percentile":25203.8,"90th_percentile":25203.8},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11138.97,"10th_percentile":11138.97,"90th_percentile":11138.97,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8072.36,"10th_percentile":8072.36,"90th_percentile":8072.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4258.2,"10th_percentile":4258.2,"90th_percentile":4258.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10977.28,"10th_percentile":10879.84,"90th_percentile":12527.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13121.54,"10th_percentile":13121.54,"90th_percentile":13121.54,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5593.76,"maximum":15645.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11403.46},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9003.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11403.46},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13886.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11368.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15645.06},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12620.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5593.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":554.17,"10th_percentile":554.17,"90th_percentile":554.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9348.3,"maximum":26146.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19057.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15047.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19057.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23207.05},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18999.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26146.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21092.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9348.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":32250.33,"10th_percentile":32250.33,"90th_percentile":32250.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5094.99,"10th_percentile":95.51,"90th_percentile":9813.57,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8711.62,"10th_percentile":95.51,"90th_percentile":10321.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":23509.88,"10th_percentile":18318.81,"90th_percentile":29249.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9888.18,"10th_percentile":9888.18,"90th_percentile":9888.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5439.67,"10th_percentile":4715.55,"90th_percentile":9134.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5508.81,"10th_percentile":5508.81,"90th_percentile":5508.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":17510.49,"10th_percentile":17510.49,"90th_percentile":17510.49,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":8318.95,"10th_percentile":4054.78,"90th_percentile":10223.43,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10926.25,"10th_percentile":10723.83,"90th_percentile":11229.88,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5085.95,"maximum":14224.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5085.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5085.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10368.23},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8186.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10368.23},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12625.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5085.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5085.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5085.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5085.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10336.6},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14224.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11475.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5085.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5085.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":18068.95,"10th_percentile":18068.95,"90th_percentile":18068.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5533.0,"10th_percentile":5533.0,"90th_percentile":5533.0,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":80501.78,"maximum":225153.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80501.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80501.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":164111.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":129577.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":164111.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":199844.73},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80501.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80501.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80501.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80501.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163610.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225153.57},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181632.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80501.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":80501.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":37928.04,"maximum":106080.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37928.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37928.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":77320.27},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61049.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":77320.27},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94155.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37928.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37928.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37928.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37928.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77084.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106080.06},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85575.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37928.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":37928.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":41738.77,"maximum":116738.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41738.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41738.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85088.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67183.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85088.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103616.0},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41738.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41738.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41738.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41738.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84829.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116738.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94173.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41738.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":41738.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":32448.79,"maximum":90755.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32448.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32448.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":66150.24},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52230.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":66150.24},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80553.73},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32448.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32448.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32448.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32448.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65948.4},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90755.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73212.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32448.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":32448.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7767.97,"maximum":21726.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15835.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12503.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15835.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19283.88},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15787.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21726.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17526.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7767.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7767.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25733.43,"maximum":71973.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52460.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41421.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52460.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63882.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52300.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71973.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58061.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25733.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":29341.46,"maximum":82064.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29341.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29341.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59815.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47228.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59815.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72839.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29341.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29341.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29341.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29341.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59633.11},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82064.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66201.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29341.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29341.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6536.84,"maximum":18282.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13326.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10521.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13326.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16227.63},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13285.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18282.74},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14748.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6536.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6731.09,"10th_percentile":6731.09,"90th_percentile":6731.09,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":12212.75,"10th_percentile":12212.75,"90th_percentile":12212.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":26965.18,"10th_percentile":26965.18,"90th_percentile":26965.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6136.99,"10th_percentile":6136.99,"90th_percentile":6136.99,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5897.21,"10th_percentile":5897.21,"90th_percentile":5897.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14436.02,"10th_percentile":14436.02,"90th_percentile":14436.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12139.85,"maximum":33953.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24748.34},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19540.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24748.34},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30137.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24672.83},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33953.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27390.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12139.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12139.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11612.12,"maximum":32477.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23672.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18691.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23672.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28826.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23600.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32477.67},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26199.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11612.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6494.88,"maximum":18165.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13240.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10454.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13240.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16123.46},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13200.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18165.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14654.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6494.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6851.2,"maximum":19161.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13966.89},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11027.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13966.89},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17008.02},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13924.27},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19161.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15458.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6851.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6851.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1089.04,"10th_percentile":1089.04,"90th_percentile":1089.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":16201.62,"10th_percentile":16201.62,"90th_percentile":16201.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4860.21,"10th_percentile":4860.21,"90th_percentile":4860.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5664.7,"10th_percentile":5664.7,"90th_percentile":5664.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":30777.42,"maximum":86080.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62742.97},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49540.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62742.97},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76404.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62551.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86080.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69441.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":30777.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32326.23,"10th_percentile":32326.23,"90th_percentile":32326.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32467.41,"10th_percentile":32467.41,"90th_percentile":32467.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11969.15,"maximum":33476.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11969.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11969.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24400.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19265.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24400.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29713.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11969.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11969.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11969.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11969.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24325.92},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33476.25},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27005.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11969.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11969.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12826.9,"10th_percentile":12826.9,"90th_percentile":12826.9,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":38865.37,"10th_percentile":36501.71,"90th_percentile":40074.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":37117.66,"10th_percentile":37117.66,"90th_percentile":37117.66,"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":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10048.04,"10th_percentile":10048.04,"90th_percentile":10048.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23864.81,"10th_percentile":23864.81,"90th_percentile":23864.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":26494.5,"10th_percentile":26494.5,"90th_percentile":26494.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11469.56,"10th_percentile":11469.56,"90th_percentile":11469.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10701.76,"maximum":29931.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21816.65},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17225.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21816.65},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26566.98},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21750.08},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29931.49},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24145.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10701.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":14736.99,"10th_percentile":14736.99,"90th_percentile":14736.99,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20639.66,"maximum":57726.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42076.1},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33222.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42076.1},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51237.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41947.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57726.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46568.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20639.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11321.94,"maximum":31666.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23080.96},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18224.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23080.96},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28106.59},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23010.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31666.07},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25545.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11321.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6573.82,"maximum":18386.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13401.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10581.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13401.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16319.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13360.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18386.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14832.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6573.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6079.52,"maximum":17003.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12393.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9785.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12393.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15092.35},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12355.93},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17003.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13716.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6079.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6079.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5544.69,"maximum":15507.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11303.42},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8924.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11303.42},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13764.62},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11268.93},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15507.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12510.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5544.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5969.44,"10th_percentile":536.18,"90th_percentile":6867.15,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4576.34,"10th_percentile":4576.34,"90th_percentile":6271.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":16731.02,"10th_percentile":11313.57,"90th_percentile":31924.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":15232.02,"10th_percentile":15232.02,"90th_percentile":22426.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":18120.33,"10th_percentile":18120.33,"90th_percentile":18120.33},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6270.69,"10th_percentile":6270.69,"90th_percentile":6294.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":465.1,"10th_percentile":465.1,"90th_percentile":4776.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4464.36,"10th_percentile":4464.36,"90th_percentile":4464.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":15507.8,"10th_percentile":15507.8,"90th_percentile":15507.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":12521.47,"10th_percentile":12521.47,"90th_percentile":12521.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5798.41,"10th_percentile":902.27,"90th_percentile":6266.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6992.01,"10th_percentile":6992.01,"90th_percentile":6992.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":38907.39,"maximum":108819.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79316.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62626.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79316.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96587.15},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79074.76},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108819.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87785.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":38907.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11809.84,"maximum":33030.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11809.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11809.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24075.59},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19009.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24075.59},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29317.79},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11809.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11809.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11809.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11809.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24002.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33030.67},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26646.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11809.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11809.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12357.48,"maximum":34562.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12357.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12357.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25192.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19890.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25192.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30677.3},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12357.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12357.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12357.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12357.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25115.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34562.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27881.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12357.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12357.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":64078.25,"maximum":179218.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64078.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64078.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":130630.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":103141.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":130630.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":159073.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64078.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64078.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64078.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64078.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130231.61},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179218.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144577.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64078.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":64078.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11594.34,"maximum":32427.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23636.27},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18662.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23636.27},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28782.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23564.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32427.94},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26159.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11594.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11425.66,"10th_percentile":11425.66,"90th_percentile":11425.66,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7222.07,"10th_percentile":7222.07,"90th_percentile":7222.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5883.94,"maximum":16456.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5883.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5883.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11995.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9470.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11995.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14606.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5883.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5883.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5883.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5883.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11958.42},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16456.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13275.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5883.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5883.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6295.02,"10th_percentile":6295.02,"90th_percentile":6295.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4744.58,"10th_percentile":4744.58,"90th_percentile":4744.58,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5505.53,"10th_percentile":5505.53,"90th_percentile":5505.53,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":32090.98,"10th_percentile":32090.98,"90th_percentile":32090.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":39280.78,"maximum":109863.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39280.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39280.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":80077.98},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63227.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":80077.98},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97514.09},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39280.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39280.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39280.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39280.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79833.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109863.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88627.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39280.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":39280.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":21572.78,"maximum":60336.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43978.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34724.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43978.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53554.18},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43844.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60336.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48673.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21572.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":21572.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc Or Insertion Of Antibiotic-Eluting","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24569.87,"maximum":68718.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50088.25},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39548.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50088.25},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60994.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49935.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68718.9},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55435.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24569.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":24569.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14872.36,"maximum":41596.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30318.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23938.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30318.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36920.46},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30226.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41596.16},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33555.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14872.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14872.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16344.58,"10th_percentile":16344.58,"90th_percentile":16344.58,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16613.33,"10th_percentile":16613.33,"90th_percentile":16613.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":61344.68,"10th_percentile":61344.68,"90th_percentile":61344.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12829.73,"maximum":35883.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12829.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12829.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26154.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20651.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26154.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31849.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12829.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12829.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12829.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12829.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26074.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35883.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28947.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12829.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12829.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13294.16,"maximum":37182.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13294.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13294.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27101.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21398.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27101.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33002.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13294.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13294.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13294.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13294.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27018.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37182.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29995.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13294.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13294.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11544.33,"10th_percentile":11544.33,"90th_percentile":11544.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11196.77,"maximum":31315.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22825.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18022.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22825.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27795.84},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22756.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31315.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25262.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11196.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20413.49,"maximum":57094.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20413.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20413.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41615.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32858.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41615.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50676.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20413.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20413.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20413.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20413.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41488.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57094.02},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46058.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20413.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20413.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21997.92,"10th_percentile":21997.92,"90th_percentile":21997.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14008.94,"maximum":39181.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28558.68},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22549.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28558.68},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34777.02},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28471.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39181.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31607.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14008.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5947.24,"maximum":16633.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12124.06},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9572.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12124.06},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14763.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12087.07},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16633.69},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13418.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5947.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9400.93,"maximum":26293.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19164.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15131.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19164.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23337.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19106.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26293.25},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21210.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9400.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6368.99,"maximum":17813.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12983.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10251.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12983.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15810.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12944.24},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17813.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14370.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6368.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64.79,"10th_percentile":64.79,"90th_percentile":64.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5725.26,"10th_percentile":421.28,"90th_percentile":7092.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":24689.36,"maximum":69053.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50331.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39740.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50331.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61291.04},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50178.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69053.09},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55705.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":24689.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13702.4,"maximum":38323.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13702.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13702.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27933.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22055.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27933.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34016.05},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13702.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13702.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13702.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13702.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27848.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38323.93},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30916.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13702.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13702.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7698.98,"maximum":21533.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15695.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12392.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15695.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19112.62},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15647.28},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21533.09},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17370.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7698.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10469.9,"maximum":29283.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10469.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10469.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21343.98},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16852.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21343.98},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25991.4},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10469.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10469.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10469.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10469.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21278.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29283.01},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23622.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10469.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10469.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10326.22,"10th_percentile":10326.22,"90th_percentile":10326.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12205.37,"10th_percentile":12205.37,"90th_percentile":12205.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10087.26,"maximum":28212.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10087.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10087.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20563.93},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16236.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20563.93},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25041.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10087.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10087.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10087.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10087.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20501.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28212.82},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22759.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10087.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10087.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10664.06,"maximum":29826.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21739.8},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17165.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21739.8},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26473.41},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21673.47},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29826.06},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24060.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10664.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9499.08,"maximum":26567.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19364.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15289.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19364.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23581.35},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19305.78},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26567.76},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21432.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9499.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":19254.67,"10th_percentile":19254.67,"90th_percentile":19254.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":89771.17,"10th_percentile":89771.17,"90th_percentile":89771.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9297.44,"10th_percentile":9297.44,"90th_percentile":9297.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22968.91,"maximum":64241.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22968.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22968.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46824.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36971.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46824.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57020.05},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22968.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22968.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22968.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22968.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46681.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64241.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51823.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22968.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22968.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9400.22,"maximum":26291.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19163.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15130.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19163.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23335.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19104.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26291.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21209.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9400.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10481.24,"10th_percentile":10481.24,"90th_percentile":10481.24,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10397.68,"10th_percentile":10397.68,"90th_percentile":10397.68,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":620.42,"10th_percentile":620.42,"90th_percentile":10062.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19369.38,"10th_percentile":19369.38,"90th_percentile":19369.38,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":20979.04,"10th_percentile":20979.04,"90th_percentile":20979.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8631.97,"10th_percentile":310.24,"90th_percentile":10478.82,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20767.68,"maximum":58084.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42337.08},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33428.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42337.08},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51555.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42207.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58084.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46857.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20767.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10533.2,"maximum":29460.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21473.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16954.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21473.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26148.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21407.5},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29460.05},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23765.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10533.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10533.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11708.97,"10th_percentile":11708.97,"90th_percentile":11708.97,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11047.25,"10th_percentile":11047.25,"90th_percentile":11047.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":73602.92,"10th_percentile":73602.92,"90th_percentile":73602.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":26410.82,"10th_percentile":26410.82,"90th_percentile":26410.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11606.47,"10th_percentile":11606.47,"90th_percentile":11606.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4221.75,"10th_percentile":4221.75,"90th_percentile":4221.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4951.86,"10th_percentile":4951.86,"90th_percentile":4951.86,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":11958.65,"10th_percentile":11958.65,"90th_percentile":11958.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7237.72,"10th_percentile":7237.72,"90th_percentile":11737.42,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9562.38,"maximum":26744.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19493.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15391.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19493.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23738.49},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19434.42},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26744.79},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21575.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9562.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6420.2,"maximum":17956.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13088.25},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10334.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13088.25},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15938.07},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13048.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17956.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14485.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6420.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20939.08,"maximum":58564.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42686.51},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33704.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42686.51},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51981.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42556.26},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58564.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47243.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20939.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5693.33,"maximum":15923.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11606.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9164.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11606.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14133.63},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11571.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15923.55},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12845.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5693.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5693.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6147.97,"10th_percentile":6147.97,"90th_percentile":6513.49,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6308.65,"10th_percentile":6308.65,"90th_percentile":6308.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":31080.1,"10th_percentile":31080.1,"90th_percentile":31080.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4810.31,"10th_percentile":4810.31,"90th_percentile":5568.9,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9804.86,"10th_percentile":9804.86,"90th_percentile":9804.86,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6501.82,"10th_percentile":6501.82,"90th_percentile":6501.82,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15722.27,"maximum":43973.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32051.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25306.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32051.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39030.35},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31953.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43973.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35473.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15722.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15722.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7128.58,"maximum":19937.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14532.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11474.33},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14532.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17696.61},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14488.01},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19937.75},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16083.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7128.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":21706.75,"10th_percentile":21706.75,"90th_percentile":21706.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8004.72,"10th_percentile":8004.72,"90th_percentile":8004.72,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":16302.15,"10th_percentile":16302.15,"90th_percentile":16302.15,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9336.21,"maximum":26112.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19032.84},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15027.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19032.84},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23177.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18974.76},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26112.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21064.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9336.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":29847.14,"maximum":83478.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60846.5},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48042.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60846.5},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74095.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60660.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83478.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67342.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29847.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29847.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32366.42,"10th_percentile":32366.42,"90th_percentile":32366.42,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11442.85,"maximum":32004.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23327.44},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18418.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23327.44},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28406.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23256.26},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32004.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25818.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11442.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11040.23,"10th_percentile":10829.53,"90th_percentile":12940.69,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":49158.23,"maximum":137489.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49158.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49158.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":100214.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":79126.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":100214.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":122034.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49158.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49158.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49158.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49158.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99908.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137489.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110913.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49158.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":49158.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12970.55,"maximum":36277.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26441.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20877.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26441.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32199.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26361.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36277.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29264.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7931.73,"10th_percentile":7931.73,"90th_percentile":7931.73,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14283.27,"10th_percentile":14283.27,"90th_percentile":14283.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19270.56,"maximum":53897.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39285.04},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31018.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39285.04},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47838.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39165.17},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53897.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43479.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19270.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19270.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11602.87,"maximum":32451.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23653.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18676.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23653.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28804.0},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23581.5},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32451.81},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26179.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11602.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11602.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11084.39,"maximum":31001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22596.69},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17841.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22596.69},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27516.88},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22527.74},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31001.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25009.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5662.29,"10th_percentile":5662.29,"90th_percentile":5662.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9096.05,"10th_percentile":9096.05,"90th_percentile":9096.05,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39301.32,"10th_percentile":39301.32,"90th_percentile":39301.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5731.74,"maximum":16030.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11684.74},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9225.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11684.74},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14228.97},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11649.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16030.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12932.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5731.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6564.82,"10th_percentile":5647.35,"90th_percentile":6709.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6570.8,"10th_percentile":6570.8,"90th_percentile":6570.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6003.85,"10th_percentile":6003.85,"90th_percentile":6003.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6560.12,"10th_percentile":6560.12,"90th_percentile":6629.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3036.69,"10th_percentile":3036.69,"90th_percentile":3036.69,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7117.12,"10th_percentile":7117.12,"90th_percentile":7117.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4732.83,"10th_percentile":4732.83,"90th_percentile":4732.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6581.4,"10th_percentile":6319.24,"90th_percentile":6608.87,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6800.08,"10th_percentile":6800.08,"90th_percentile":6800.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6907.39,"maximum":19319.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14081.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11118.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14081.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17147.51},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14038.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19319.11},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15584.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6907.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7663.59,"10th_percentile":7663.59,"90th_percentile":7663.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6777.53,"10th_percentile":6777.53,"90th_percentile":6777.53,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2857.21,"10th_percentile":2857.21,"90th_percentile":2857.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7370.17,"10th_percentile":7370.17,"90th_percentile":7370.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":77338.98,"maximum":216307.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77338.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77338.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":157663.58},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":124486.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":157663.58},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":191993.11},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77338.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77338.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77338.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77338.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":157182.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":216307.6},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174496.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77338.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":77338.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":35847.0,"maximum":100259.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35847.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35847.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73077.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":57700.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73077.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88989.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35847.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35847.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35847.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35847.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72854.88},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100259.66},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80880.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35847.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":35847.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":29791.66,"maximum":83323.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60733.41},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47953.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60733.41},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73957.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60548.1},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83323.61},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67217.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29791.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29791.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15522.42,"maximum":43414.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31644.07},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24985.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31644.07},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38534.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31547.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43414.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35022.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15522.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15522.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22347.3,"maximum":62502.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22347.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22347.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45557.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35970.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45557.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55476.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22347.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22347.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22347.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22347.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45418.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62502.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50421.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22347.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22347.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":43586.52,"maximum":121906.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43586.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43586.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":88855.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":70157.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":88855.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108203.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43586.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43586.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43586.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43586.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88584.55},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121906.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98342.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43586.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":43586.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":23411.29,"maximum":65478.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23411.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23411.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47726.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37683.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47726.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58118.26},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23411.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23411.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23411.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23411.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47580.73},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65478.5},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52821.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23411.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":23411.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5142.85,"maximum":14383.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10484.23},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8278.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10484.23},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12767.05},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10452.24},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14383.91},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11603.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5142.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5858.32,"10th_percentile":5858.32,"90th_percentile":5858.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":67318.25,"10th_percentile":67318.25,"90th_percentile":67318.25},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5144.41,"10th_percentile":5144.41,"90th_percentile":5144.41,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":14423.69,"10th_percentile":14423.69,"90th_percentile":14423.69,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6612.23,"maximum":18493.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6612.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6612.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13479.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10643.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13479.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16414.78},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6612.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6612.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6612.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6612.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13438.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18493.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14918.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6612.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6612.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7592.29,"maximum":21234.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7592.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7592.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15477.68},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12220.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15477.68},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18847.78},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7592.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7592.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7592.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7592.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15430.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21234.71},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17130.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7592.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7592.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":15521.18,"10th_percentile":15521.18,"90th_percentile":15521.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8212.3,"10th_percentile":8212.3,"90th_percentile":8212.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8563.11,"maximum":23949.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17456.8},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13783.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17456.8},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21257.82},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17403.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23949.97},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19320.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9466.65,"10th_percentile":9466.65,"90th_percentile":9466.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":37959.61,"10th_percentile":37959.61,"90th_percentile":37959.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":87.41,"10th_percentile":87.41,"90th_percentile":87.41,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":19320.59,"10th_percentile":19320.59,"90th_percentile":19320.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9505.07,"10th_percentile":9505.07,"90th_percentile":9505.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4851.24,"maximum":13568.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4851.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4851.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9889.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7808.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9889.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12043.16},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4851.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4851.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4851.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4851.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9859.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13568.33},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10945.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4851.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4851.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":10360.0,"10th_percentile":10360.0,"90th_percentile":10360.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22410.6,"maximum":62679.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22410.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22410.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45686.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36072.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45686.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55634.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22410.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22410.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22410.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22410.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45546.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62679.69},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50564.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22410.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22410.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21631.54,"10th_percentile":21631.54,"90th_percentile":21631.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":51089.74,"10th_percentile":51089.74,"90th_percentile":51089.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25751.21,"maximum":72022.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52496.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41449.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52496.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63927.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52336.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72022.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58101.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25751.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8436.51,"maximum":23595.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17198.71},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13579.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17198.71},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20943.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17146.24},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23595.89},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19034.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8436.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18000.51,"10th_percentile":18000.51,"90th_percentile":18000.51,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11965.6,"maximum":33466.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24393.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19260.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24393.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29704.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24318.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33466.3},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26997.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11965.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13085.53,"10th_percentile":13085.53,"90th_percentile":13085.53,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7113.64,"maximum":19895.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14501.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11450.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14501.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17659.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14457.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19895.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16050.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7113.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7113.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13001.14,"maximum":36362.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26504.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20926.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26504.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32275.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26423.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36362.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29333.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13001.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11292.16,"10th_percentile":11292.16,"90th_percentile":11292.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":27797.3,"10th_percentile":27797.3,"90th_percentile":36280.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6964.26,"10th_percentile":6964.26,"90th_percentile":9459.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11253.66,"maximum":31475.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22941.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18114.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22941.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27937.09},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22871.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31475.11},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25391.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11253.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11374.57,"maximum":31813.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23188.25},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18308.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23188.25},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28237.24},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23117.5},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31813.28},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25663.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11374.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11374.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10840.78,"10th_percentile":10840.78,"90th_percentile":10840.78,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12178.81,"10th_percentile":12178.81,"90th_percentile":12178.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12875.0,"10th_percentile":12875.0,"90th_percentile":12875.0,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20626.86,"maximum":57690.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42050.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33201.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42050.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51205.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41921.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57690.78},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46539.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20626.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25337.99,"maximum":70867.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25337.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25337.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51654.14},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40784.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51654.14},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62901.27},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25337.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25337.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25337.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25337.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51496.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70867.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57169.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25337.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25337.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9953.55,"maximum":27838.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20291.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16021.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20291.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24709.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20229.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27838.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22457.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9953.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9953.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":41016.88,"maximum":114719.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41016.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41016.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":83617.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":66021.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":83617.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101823.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41016.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41016.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41016.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41016.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83362.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114719.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92544.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41016.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":41016.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5982.8,"maximum":16733.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12196.56},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9630.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12196.56},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14852.23},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12159.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16733.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13498.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5982.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4706.27,"10th_percentile":4706.27,"90th_percentile":4706.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6888.41,"10th_percentile":6888.41,"90th_percentile":6888.41,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6965.03,"10th_percentile":6965.03,"90th_percentile":6965.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37878.22,"10th_percentile":37878.22,"90th_percentile":37878.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5459.15,"10th_percentile":5459.15,"90th_percentile":5459.15,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":14028.16,"10th_percentile":14028.16,"90th_percentile":14028.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4992.57,"10th_percentile":4992.57,"90th_percentile":5521.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47521.0,"maximum":132910.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47521.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47521.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":96876.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":76490.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":96876.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117970.33},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47521.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47521.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47521.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47521.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96580.92},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132910.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107219.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47521.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":47521.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18918.5,"maximum":52912.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18918.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18918.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38567.34},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30451.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38567.34},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46964.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18918.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18918.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18918.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18918.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38449.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52912.72},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42685.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18918.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18918.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":41394.45,"10th_percentile":41394.45,"90th_percentile":41394.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13718.76,"maximum":38369.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27967.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22082.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27967.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34056.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27881.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38369.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30953.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13718.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13718.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16185.01,"10th_percentile":16185.01,"90th_percentile":16185.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14006.5,"10th_percentile":14006.5,"90th_percentile":14006.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14592.61,"10th_percentile":14592.61,"90th_percentile":14592.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17490.37,"maximum":48918.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35655.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28152.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35655.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43419.64},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35547.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48918.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39462.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17490.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11139.16,"maximum":31154.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22708.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17929.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22708.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27652.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22639.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31154.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25132.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11139.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11139.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12217.59,"10th_percentile":12217.59,"90th_percentile":12217.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":3718.98,"maximum":10401.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3718.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3718.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7581.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":5986.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":7581.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9232.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3718.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3718.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3718.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3718.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7558.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10401.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8390.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3718.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":3718.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2232.18,"10th_percentile":2232.18,"90th_percentile":2232.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":18657.36,"10th_percentile":18657.36,"90th_percentile":18657.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":5767.77,"10th_percentile":5767.77,"90th_percentile":5767.77},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7513.58,"10th_percentile":7513.58,"90th_percentile":7513.58,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":7887.99,"10th_percentile":7887.99,"90th_percentile":7887.99,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2258.89,"10th_percentile":2258.89,"90th_percentile":2258.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9597.23,"maximum":26842.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19564.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15447.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19564.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23825.01},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19505.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26842.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21653.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9597.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9377.54,"10th_percentile":9377.54,"90th_percentile":9377.54,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16227.24,"maximum":45385.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33080.92},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26119.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33080.92},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40283.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32979.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45385.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36612.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16227.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16227.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9003.36,"maximum":25181.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18354.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14492.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18354.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22350.73},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18298.28},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25181.28},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20313.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9003.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7515.47,"10th_percentile":7515.47,"90th_percentile":7515.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9639.85,"10th_percentile":9639.85,"90th_percentile":9672.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13576.51,"maximum":37971.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27677.14},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21853.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27677.14},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33703.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27592.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37971.84},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30632.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13576.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":29655.11,"maximum":82941.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60455.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47733.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60455.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73618.46},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60270.57},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82941.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66909.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29655.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29655.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":3715.29,"10th_percentile":3715.29,"90th_percentile":3715.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5805.98,"10th_percentile":5805.98,"90th_percentile":5805.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":12270.95,"10th_percentile":12270.95,"90th_percentile":12270.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3970.25,"10th_percentile":3970.25,"90th_percentile":3970.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6812.08,"maximum":19052.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13887.14},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10964.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13887.14},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16910.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13844.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19052.56},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15369.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6812.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":25661.85,"10th_percentile":25661.85,"90th_percentile":25661.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":14056.0,"10th_percentile":14056.0,"90th_percentile":14056.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":34314.88,"10th_percentile":34314.88,"90th_percentile":34314.88},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4488.7,"10th_percentile":4488.7,"90th_percentile":4488.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3708.44,"10th_percentile":3708.44,"90th_percentile":3708.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36038.4,"10th_percentile":36038.4,"90th_percentile":36038.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":17069.98,"10th_percentile":17069.98,"90th_percentile":17069.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7312.19,"10th_percentile":7312.19,"90th_percentile":7312.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4057.52,"maximum":11348.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4057.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4057.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8271.68},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":6531.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":8271.68},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10072.75},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4057.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4057.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4057.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4057.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8246.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11348.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9154.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4057.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4057.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10496.21,"maximum":29356.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21397.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16894.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21397.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26056.72},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21332.33},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29356.61},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23682.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10496.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13049.5,"maximum":36497.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13049.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13049.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26602.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21004.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26602.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32395.23},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13049.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13049.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13049.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13049.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26521.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36497.84},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29443.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13049.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13049.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13087.08,"10th_percentile":13087.08,"90th_percentile":13087.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15149.03,"maximum":42369.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30882.87},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24384.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30882.87},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37607.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30788.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42369.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34180.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15149.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8127.13,"maximum":22730.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16568.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13081.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16568.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20175.51},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16517.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22730.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18336.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8127.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8127.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7821.31,"maximum":21875.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7821.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7821.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15944.55},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12589.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15944.55},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19416.3},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7821.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7821.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7821.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7821.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15895.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21875.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17646.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7821.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7821.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8593.69,"maximum":24035.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17519.14},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13832.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17519.14},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21333.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17465.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24035.5},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19389.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8593.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12750.79,"maximum":35662.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25993.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20523.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25993.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31653.68},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25914.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35662.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28769.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12750.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12750.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7270.82,"maximum":20335.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14822.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11703.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14822.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18049.73},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14777.1},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20335.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16404.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7270.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7270.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15061.55,"maximum":42125.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30704.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24243.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30704.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37390.11},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30610.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42125.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33982.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15061.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15061.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16262.31,"10th_percentile":16262.31,"90th_percentile":16262.31,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14451.42,"10th_percentile":14451.42,"90th_percentile":14451.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":42763.4,"10th_percentile":42763.4,"90th_percentile":42763.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16162.01,"10th_percentile":16162.01,"90th_percentile":16162.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16304.67,"10th_percentile":16304.67,"90th_percentile":16304.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9219.57,"maximum":25786.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18795.05},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14840.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18795.05},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22887.47},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18737.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25786.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20801.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":30819.79,"10th_percentile":30819.79,"90th_percentile":30819.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4747.09,"10th_percentile":4747.09,"90th_percentile":4747.09,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13732.98,"maximum":38409.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27996.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22104.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27996.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34091.97},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27910.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38409.46},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30985.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13732.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13732.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5907.41,"maximum":16522.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12042.87},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9508.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12042.87},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14665.07},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12006.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16522.3},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13328.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5907.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6533.95,"10th_percentile":6533.95,"90th_percentile":6533.95,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59.18,"10th_percentile":59.18,"90th_percentile":59.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":282.68,"10th_percentile":282.68,"90th_percentile":282.68,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":323.79,"10th_percentile":323.79,"90th_percentile":707.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10978.42,"maximum":30705.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22380.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17671.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22380.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27253.8},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22312.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30705.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24770.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10978.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10978.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12780.66,"maximum":35745.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26054.7},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20572.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26054.7},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31727.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25975.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35745.92},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28836.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12780.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12780.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12264.31,"maximum":34301.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25002.08},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19740.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25002.08},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30446.01},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24925.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34301.76},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27671.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12264.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11856.78,"maximum":33161.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24171.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19084.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24171.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29434.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24097.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33161.95},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26751.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11856.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11856.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6514.79,"maximum":18221.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13281.08},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10486.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13281.08},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16172.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13240.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18221.07},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14699.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6514.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7493.93,"10th_percentile":7493.93,"90th_percentile":7493.93,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13351.86,"10th_percentile":13351.86,"90th_percentile":13351.86,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5866.07,"10th_percentile":5866.07,"90th_percentile":5866.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6979.8,"10th_percentile":6979.8,"90th_percentile":6979.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20535.82,"maximum":57436.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41864.41},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33054.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41864.41},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50979.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41736.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57436.16},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46334.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20535.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20535.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9447.16,"maximum":26422.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19259.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15206.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19259.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23452.46},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19200.26},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26422.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21315.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9447.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9447.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5534.73,"maximum":15479.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11283.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8908.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11283.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13739.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11248.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15479.95},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12487.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5534.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5982.24,"10th_percentile":1010.24,"90th_percentile":6311.95,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5983.57,"10th_percentile":5983.57,"90th_percentile":5983.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":21810.04,"10th_percentile":21810.04,"90th_percentile":21810.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56.63,"10th_percentile":56.63,"90th_percentile":56.63,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":14608.22,"10th_percentile":14608.22,"90th_percentile":14608.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5722.85,"10th_percentile":168.42,"90th_percentile":6282.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6325.44,"10th_percentile":6325.44,"90th_percentile":6325.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":36957.93,"maximum":103366.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":75342.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59488.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":75342.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91747.64},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75112.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103366.79},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83386.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36957.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":36957.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7363.99,"maximum":20596.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15012.26},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11853.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15012.26},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18281.02},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14966.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20596.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16615.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7363.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8171.98,"10th_percentile":8171.98,"90th_percentile":8171.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5250.0,"10th_percentile":5250.0,"90th_percentile":5250.0,"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":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9794.22,"10th_percentile":9794.22,"90th_percentile":9794.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8126.43,"10th_percentile":8126.43,"90th_percentile":8126.43,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11038.16,"maximum":30872.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22502.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17767.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22502.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27402.11},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22433.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30872.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24904.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11038.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12595.88,"10th_percentile":12595.88,"90th_percentile":12595.88,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6228.88,"maximum":17421.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12698.22},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10026.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12698.22},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15463.12},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12659.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17421.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14053.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6228.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6600.24,"10th_percentile":6600.24,"90th_percentile":7161.24,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6782.6,"10th_percentile":6782.6,"90th_percentile":6782.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7083.43,"10th_percentile":7083.43,"90th_percentile":7083.43,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4817.61,"10th_percentile":4817.61,"90th_percentile":7056.15,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3680.19,"10th_percentile":3680.19,"90th_percentile":3680.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":13276.64,"10th_percentile":13276.64,"90th_percentile":13276.64,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5542.39,"10th_percentile":203.27,"90th_percentile":6234.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6533.32,"10th_percentile":6533.32,"90th_percentile":6533.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5559.62,"maximum":15549.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5559.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5559.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11333.87},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8948.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11333.87},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13801.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5559.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5559.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5559.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5559.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11299.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15549.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12543.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5559.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5559.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6275.45,"10th_percentile":6275.45,"90th_percentile":6275.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56.82,"10th_percentile":56.82,"90th_percentile":56.82,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8528.97,"maximum":23854.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17387.2},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13728.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17387.2},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21173.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17334.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23854.49},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19243.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8528.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9210.32,"maximum":25760.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18776.21},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14825.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18776.21},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22864.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18718.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25760.14},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20780.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9210.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":29970.18,"maximum":83822.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61097.34},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48240.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61097.34},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74400.62},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60910.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83822.9},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67620.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29970.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9028.25,"maximum":25250.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18405.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14532.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18405.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22412.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18348.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25250.9},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20370.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9028.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1861.54,"10th_percentile":1861.54,"90th_percentile":1861.54,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10073.84,"10th_percentile":10073.84,"90th_percentile":10073.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6360.47,"10th_percentile":6360.47,"90th_percentile":6360.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92.27,"10th_percentile":92.27,"90th_percentile":92.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":12435.86,"10th_percentile":12435.86,"90th_percentile":12435.86,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8845.82,"10th_percentile":8845.82,"90th_percentile":8845.82,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":27696.4,"maximum":77463.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27696.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27696.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56462.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44580.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56462.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68756.0},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27696.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27696.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27696.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27696.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56289.73},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77463.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62490.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27696.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":27696.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13021.05,"maximum":36418.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26544.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20959.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26544.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32324.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26463.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36418.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29378.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13021.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6145.97,"10th_percentile":6145.97,"90th_percentile":6145.97,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10285.75,"10th_percentile":10285.75,"90th_percentile":10285.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14190.3,"maximum":39688.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14190.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14190.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28928.4},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22841.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28928.4},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35227.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14190.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14190.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14190.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14190.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28840.14},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39688.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32016.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14190.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14190.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15575.23,"10th_percentile":15575.23,"90th_percentile":15575.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15590.77,"10th_percentile":15590.77,"90th_percentile":15590.77,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":23658.56,"10th_percentile":23658.56,"90th_percentile":23658.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6278.67,"maximum":17560.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12799.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10106.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12799.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15586.72},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12760.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17560.66},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14166.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6278.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":16939.98,"10th_percentile":16939.98,"90th_percentile":16939.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3162.32,"10th_percentile":3162.32,"90th_percentile":3162.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66.28,"10th_percentile":66.28,"90th_percentile":66.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":10585.89,"10th_percentile":10585.89,"90th_percentile":10585.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3162.32,"10th_percentile":3162.32,"90th_percentile":3162.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7679.92,"10th_percentile":7679.92,"90th_percentile":7679.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3678.78,"10th_percentile":3678.78,"90th_percentile":4286.38,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":13811.72,"10th_percentile":13811.72,"90th_percentile":13811.72,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4424.85,"10th_percentile":4331.55,"90th_percentile":5672.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7425.9,"10th_percentile":7425.9,"90th_percentile":7425.9,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13984.76,"maximum":39113.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13984.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13984.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28509.38},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22510.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28509.38},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34716.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13984.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13984.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13984.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13984.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28422.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39113.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31553.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13984.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13984.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5189.79,"maximum":14515.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5189.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5189.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10579.92},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8353.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10579.92},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12883.58},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5189.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5189.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5189.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5189.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10547.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14515.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11709.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5189.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5189.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9906.61,"maximum":27707.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20195.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15945.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20195.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24593.04},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20134.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27707.57},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22351.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9906.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6041.12,"maximum":16896.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12315.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9723.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12315.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14997.01},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12277.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16896.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13630.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6041.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6041.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":23007.32,"maximum":64348.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46902.82},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37033.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46902.82},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57115.39},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46759.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64348.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51910.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":23007.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":235.13,"10th_percentile":235.13,"90th_percentile":235.13,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27079.8,"10th_percentile":27079.8,"90th_percentile":27079.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5132.18,"maximum":14354.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5132.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5132.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10462.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8260.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10462.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12740.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5132.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5132.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5132.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5132.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10430.55},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14354.07},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11579.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5132.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5132.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10803.49,"10th_percentile":10803.49,"90th_percentile":10803.49,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16113.44,"maximum":45067.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32848.93},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25936.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32848.93},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40001.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32748.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45067.32},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36356.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16113.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4494.92,"maximum":12571.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9163.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7235.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9163.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11158.59},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9135.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12571.74},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10141.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4494.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4494.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15703.07,"maximum":43919.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32012.34},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25276.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32012.34},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38982.68},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31914.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43919.55},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35430.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15703.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17631.63,"10th_percentile":17631.63,"90th_percentile":17631.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":34333.96,"10th_percentile":34333.96,"90th_percentile":34333.96,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28256.15,"10th_percentile":28256.15,"90th_percentile":28256.15,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19981.07,"maximum":55884.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40733.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32162.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40733.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49602.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40609.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55884.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45082.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19981.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17419.25,"maximum":48719.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35510.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28038.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35510.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43243.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35402.6},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48719.49},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39302.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17419.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":2670.0,"10th_percentile":2670.0,"90th_percentile":2670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":3656.18,"10th_percentile":3656.18,"90th_percentile":3656.18},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2726.98,"10th_percentile":2726.98,"90th_percentile":2726.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":636.0,"10th_percentile":636.0,"90th_percentile":636.0,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":7000.0,"10th_percentile":7000.0,"90th_percentile":7000.0,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7539.66,"maximum":21087.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15370.39},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12136.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15370.39},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18717.13},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15323.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21087.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17011.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7539.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":16365.77,"10th_percentile":16365.77,"90th_percentile":16365.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7165.56,"maximum":20041.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14607.74},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11533.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14607.74},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17788.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14563.17},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20041.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16167.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7165.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18261.33,"maximum":51074.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18261.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18261.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37227.63},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29393.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37227.63},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45333.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18261.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18261.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18261.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18261.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37114.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51074.7},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41202.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18261.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18261.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10142.74,"maximum":28367.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20677.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16325.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20677.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25179.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20613.93},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28367.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22884.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10142.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4779.41,"maximum":13367.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9743.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7693.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9743.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11864.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9713.6},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13367.42},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10783.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4779.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12870.98,"maximum":35998.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26238.84},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20717.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26238.84},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31952.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26158.78},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35998.55},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29040.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12870.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14820.44,"maximum":41450.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14820.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14820.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30213.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23855.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30213.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36791.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14820.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14820.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14820.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14820.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30120.83},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41450.95},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33438.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14820.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14820.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39861.14,"maximum":111486.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81261.1},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64161.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81261.1},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98954.82},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81013.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111486.7},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89937.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":39861.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":307125.52,"maximum":858992.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307125.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307125.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":626107.42},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":494356.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":626107.42},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":762435.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307125.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307125.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307125.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307125.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":624197.01},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":858992.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":692954.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":307125.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":307125.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22113.31,"maximum":61848.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45080.29},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35594.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45080.29},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54896.04},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44942.74},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61848.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49893.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22113.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22113.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":27529.26,"maximum":76995.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56121.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44311.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56121.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68341.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55950.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76995.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62113.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":27529.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12287.78,"maximum":34367.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25049.92},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19778.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25049.92},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30504.27},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24973.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34367.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27724.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12287.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8825.55,"maximum":24683.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17991.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14205.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17991.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21909.33},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17936.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24683.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19912.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8825.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7554.66,"10th_percentile":7554.66,"90th_percentile":7554.66,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10445.72,"maximum":29215.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21294.68},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16813.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21294.68},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25931.37},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21229.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29215.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23568.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10445.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13637.68,"maximum":38142.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27801.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21951.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27801.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33855.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27717.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38142.91},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30770.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13637.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9265.09,"maximum":25913.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9265.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9265.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18887.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14913.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18887.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23000.47},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9265.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9265.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9265.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9265.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18830.22},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25913.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20904.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9265.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9265.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95.07,"10th_percentile":95.07,"90th_percentile":95.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25030.74,"maximum":70007.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51027.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40290.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51027.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62138.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50872.08},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70007.9},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56475.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25030.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25030.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":71164.47,"10th_percentile":71164.47,"90th_percentile":71164.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7972.09,"maximum":22296.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16251.93},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12832.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16251.93},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19790.61},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16202.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22296.94},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17987.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7972.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5588.78,"maximum":15631.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11393.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8995.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11393.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13874.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11358.55},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15631.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12609.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5588.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8788.57,"maximum":24580.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17916.41},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14146.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17916.41},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21817.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17861.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24580.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19829.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8788.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9043.19,"maximum":25292.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18435.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14556.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18435.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22449.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18379.23},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25292.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20403.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9043.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6518.35,"maximum":18231.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13288.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10492.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13288.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16181.72},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13247.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18231.02},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14707.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6518.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4281.83,"10th_percentile":4281.83,"90th_percentile":4281.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6369.14,"10th_percentile":6369.14,"90th_percentile":6369.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":26583.34,"maximum":74350.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26583.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26583.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54192.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42789.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54192.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65992.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26583.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26583.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26583.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26583.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54027.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74350.33},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59978.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26583.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":26583.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27774.03,"10th_percentile":27774.03,"90th_percentile":27774.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5369.73,"maximum":15018.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10946.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8643.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10946.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13330.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10913.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15018.46},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12115.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5369.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6203.96,"10th_percentile":6203.96,"90th_percentile":6203.96,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6242.87,"10th_percentile":6242.87,"90th_percentile":6242.87,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":199312.11,"maximum":557451.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199312.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199312.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":406318.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":320817.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":406318.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":494789.98},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199312.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199312.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199312.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199312.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":405078.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":557451.42},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":449699.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":199312.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":199312.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Or Islet Cell Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51035.15,"maximum":142739.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":104040.47},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":82147.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":104040.47},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126694.16},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103723.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142739.02},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115148.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":51035.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50742.84,"maximum":141921.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":103444.57},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":81676.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":103444.57},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":125968.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103128.93},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141921.46},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114488.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":50742.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17943.42,"maximum":50185.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36579.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28882.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36579.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44544.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36467.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50185.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40484.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17943.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17001.76,"maximum":47551.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34659.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27366.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34659.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42206.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34554.1},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47551.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38360.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17001.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12882.36,"maximum":36030.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26262.04},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20735.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26262.04},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31980.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26181.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36030.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29065.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12882.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6541.82,"maximum":18296.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13336.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10529.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13336.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16239.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13295.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18296.66},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14760.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6541.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6147.8,"maximum":17194.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12532.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9895.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12532.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15261.85},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12494.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17194.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13871.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6147.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6147.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7007.94,"10th_percentile":7007.94,"90th_percentile":7007.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5869.0,"maximum":16414.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11964.57},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9446.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11964.57},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14569.73},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11928.07},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16414.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13241.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5869.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5869.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6505.55,"maximum":18195.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13262.24},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10471.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13262.24},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16149.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13221.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18195.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14678.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6505.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7053.77,"10th_percentile":7053.77,"90th_percentile":7053.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":120.51,"10th_percentile":120.51,"90th_percentile":120.51,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18343.83,"maximum":51305.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37395.82},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29526.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37395.82},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45538.36},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37281.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51305.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41388.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5947.95,"maximum":16635.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12125.51},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9573.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12125.51},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14765.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12088.52},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16635.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13420.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5947.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5947.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":298.0,"10th_percentile":298.0,"90th_percentile":298.0,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5937.53,"10th_percentile":5937.53,"90th_percentile":5937.53,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5679.82,"maximum":15885.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11578.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9142.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11578.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14100.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11543.57},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15885.75},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12815.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5679.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":30335.75,"maximum":84845.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30335.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30335.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61842.58},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48829.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61842.58},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75308.14},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30335.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30335.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30335.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30335.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61653.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84845.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68445.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30335.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":30335.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5669.15,"maximum":15855.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5669.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5669.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11557.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9125.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11557.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14073.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5669.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5669.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5669.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5669.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11521.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15855.91},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12791.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5669.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5669.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4915.25,"maximum":13747.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10020.26},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7911.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10020.26},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12202.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9989.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13747.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11090.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4915.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12826.18,"maximum":35873.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26147.5},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20645.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26147.5},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31840.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26067.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35873.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28939.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12826.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":233.84,"10th_percentile":233.84,"90th_percentile":233.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12560.18,"maximum":35129.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25605.23},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20217.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25605.23},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31180.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25527.11},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35129.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28339.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12560.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":128.36,"10th_percentile":128.36,"90th_percentile":128.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12820.6,"10th_percentile":12820.6,"90th_percentile":12820.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":98514.19,"maximum":275532.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":200831.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":158570.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":200831.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":244560.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200218.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":275532.05},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222273.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98514.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":98514.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20495.99,"maximum":57324.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20495.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20495.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41783.22},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32990.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41783.22},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50881.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20495.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20495.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20495.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20495.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41655.73},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57324.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46244.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20495.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20495.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22598.36,"maximum":63204.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46069.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36374.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46069.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56100.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45928.55},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63204.84},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50987.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22598.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22598.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15612.74,"maximum":43666.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31828.2},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25130.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31828.2},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38758.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31731.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43666.92},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35226.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15612.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15612.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11540.29,"maximum":32276.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23526.08},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18575.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23526.08},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28648.63},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23454.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32276.76},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26037.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11540.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11540.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8987.78,"10th_percentile":8987.78,"90th_percentile":8987.78,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12520.87,"10th_percentile":12520.87,"90th_percentile":12520.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10281.99,"10th_percentile":10281.99,"90th_percentile":10281.99,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12423.29,"10th_percentile":12423.29,"90th_percentile":12423.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7251.62,"maximum":20281.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14783.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11672.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14783.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18002.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14738.07},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20281.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16361.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7251.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9984.13,"maximum":27924.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9984.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9984.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20353.7},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16070.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20353.7},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24785.49},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9984.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9984.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9984.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9984.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20291.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27924.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22526.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9984.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9984.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7297.14,"maximum":20409.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14875.97},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11745.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14875.97},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18115.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14830.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20409.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16464.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7297.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7297.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16255.69,"maximum":45465.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33138.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26165.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33138.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40354.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33037.8},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45465.16},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36677.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16255.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5854.78,"maximum":16375.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11935.58},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9423.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11935.58},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14534.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11899.16},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16375.09},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13209.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5854.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5854.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5814.49,"10th_percentile":5814.49,"90th_percentile":5814.49,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16321.83,"maximum":45650.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33273.76},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26272.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33273.76},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40518.75},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33172.23},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45650.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36826.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16321.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16321.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10916.54,"maximum":30532.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22254.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17571.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22254.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27100.19},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22186.61},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30532.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24630.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10916.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15433.51,"maximum":43165.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31462.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24842.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31462.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38313.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31366.83},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43165.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34821.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15433.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":26646.64,"maximum":74527.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54321.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42891.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54321.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66149.97},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54156.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74527.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60121.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":26646.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5220.37,"maximum":14600.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10642.27},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8402.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10642.27},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12959.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10609.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14600.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11778.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5220.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5220.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5039.01,"maximum":14093.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5039.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5039.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10272.54},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8110.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10272.54},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12509.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5039.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5039.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5039.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5039.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10241.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14093.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11369.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5039.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5039.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9769.34,"maximum":27323.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19915.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15724.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19915.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24252.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19855.06},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27323.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22042.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9769.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11005.01,"10th_percentile":11005.01,"90th_percentile":11005.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":19265.21,"10th_percentile":19265.21,"90th_percentile":19265.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":22086.09,"10th_percentile":22086.09,"90th_percentile":22086.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10923.68,"10th_percentile":10923.68,"90th_percentile":10923.68,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15037.38,"10th_percentile":15037.38,"90th_percentile":15037.38,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26804.17,"10th_percentile":26804.17,"90th_percentile":26804.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8950.02,"10th_percentile":8950.02,"90th_percentile":8950.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6606.58,"10th_percentile":6606.58,"90th_percentile":10998.93,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9147.68,"10th_percentile":9147.68,"90th_percentile":9147.68,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5100.88,"maximum":14266.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10398.68},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8210.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10398.68},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12662.88},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10366.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14266.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11508.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5100.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13422.18,"maximum":37540.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27362.51},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21604.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27362.51},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33320.4},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27279.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37540.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30283.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13422.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13422.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14571.56,"10th_percentile":14571.56,"90th_percentile":14571.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5742.41,"maximum":16060.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11706.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9243.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11706.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14255.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11670.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16060.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12956.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5742.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":70816.36,"maximum":198064.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":144366.54},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":113987.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":144366.54},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":175800.79},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143926.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":198064.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159779.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":70816.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22399.93,"maximum":62649.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22399.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22399.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45664.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36055.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45664.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55607.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22399.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22399.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22399.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22399.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45525.27},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62649.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50540.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22399.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22399.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23755.92,"10th_percentile":23755.92,"90th_percentile":23755.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":287.35,"10th_percentile":287.35,"90th_percentile":287.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23675.95,"10th_percentile":23675.95,"90th_percentile":23675.95,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22130.95,"10th_percentile":22130.95,"90th_percentile":22130.95,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44621.71,"10th_percentile":44621.71,"90th_percentile":44621.71,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":126.71,"10th_percentile":126.71,"90th_percentile":126.71,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20273.38,"maximum":56702.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20273.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20273.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41329.4},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32632.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41329.4},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50328.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20273.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20273.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20273.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20273.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41203.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56702.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45741.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20273.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20273.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22312.57,"10th_percentile":22312.57,"90th_percentile":22312.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":42223.99,"10th_percentile":42223.99,"90th_percentile":42223.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10711.43,"10th_percentile":10711.43,"90th_percentile":10711.43,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":24809.55,"maximum":69389.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24809.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24809.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50576.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39934.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50576.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61589.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24809.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24809.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24809.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24809.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50422.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69389.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55976.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24809.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":24809.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24731.17,"10th_percentile":24731.17,"90th_percentile":24731.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":23134.62,"maximum":64704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47162.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37238.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47162.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57431.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47018.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64704.7},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52197.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":23134.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":48917.13,"maximum":136815.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48917.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48917.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":99722.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":78738.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":99722.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":121436.2},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48917.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48917.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48917.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48917.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99418.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136815.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110369.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48917.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":48917.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":42720.25,"maximum":119483.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42720.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42720.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":87089.69},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68763.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":87089.69},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106052.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42720.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42720.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42720.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42720.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86823.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119483.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96387.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42720.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":42720.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4923.08,"maximum":13769.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10036.21},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7924.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10036.21},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12221.48},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10005.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13769.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11107.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4923.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6038.27,"maximum":16888.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12309.65},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9719.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12309.65},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14989.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12272.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16888.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13623.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6038.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6038.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3856.43,"10th_percentile":3856.43,"90th_percentile":3856.43,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16996.19,"10th_percentile":16996.19,"90th_percentile":16996.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8510.48,"maximum":23802.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8510.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8510.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17349.5},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13698.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17349.5},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21127.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8510.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8510.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8510.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8510.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17296.57},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23802.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19201.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8510.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8510.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4026.23,"maximum":11260.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8207.88},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":6480.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":8207.88},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9995.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8182.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11260.86},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9084.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4026.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40.55,"10th_percentile":40.55,"90th_percentile":40.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40.55,"10th_percentile":40.55,"90th_percentile":40.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":294.29,"10th_percentile":294.29,"90th_percentile":294.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17227.22,"maximum":48182.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17227.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17227.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35119.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27729.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35119.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42766.36},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17227.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17227.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17227.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17227.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35012.32},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48182.4},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38869.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17227.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17227.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":35471.48,"maximum":99209.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35471.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35471.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72312.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":57095.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72312.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88057.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35471.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35471.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35471.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35471.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72091.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99209.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80032.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35471.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":35471.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38285.47,"10th_percentile":38285.47,"90th_percentile":38285.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38657.0,"10th_percentile":38657.0,"90th_percentile":38657.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11649.1,"maximum":32581.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23747.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18750.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23747.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28918.76},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23675.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32581.11},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26283.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11649.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9308.47,"maximum":26034.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18976.29},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14983.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18976.29},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23108.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18918.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26034.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21002.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9308.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":31242.55,"maximum":87381.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63691.21},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":50288.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":63691.21},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77559.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63496.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87381.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70491.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31242.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":31242.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32559.13,"10th_percentile":32559.13,"90th_percentile":32559.13,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12610.67,"maximum":35270.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25708.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20298.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25708.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31305.85},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25629.73},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35270.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28452.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12610.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4483.54,"maximum":12539.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9140.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7216.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9140.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11130.34},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9112.28},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12539.92},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10116.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4483.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4483.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4156.17,"10th_percentile":4156.17,"90th_percentile":4156.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":888.62,"10th_percentile":888.62,"90th_percentile":888.62,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4845.55,"maximum":13552.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9878.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7799.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9878.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12029.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9848.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13552.42},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10932.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4845.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19964.01,"10th_percentile":19964.01,"90th_percentile":19964.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":10756.3,"10th_percentile":10756.3,"90th_percentile":10756.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4615.83,"maximum":12909.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9409.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7429.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9409.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11458.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9381.14},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12909.91},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10414.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4615.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4615.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":9963.48,"10th_percentile":9963.48,"90th_percentile":9963.48,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25359.33,"maximum":70926.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51697.63},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40818.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51697.63},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62954.23},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51539.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70926.92},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57217.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25359.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25359.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9696.09,"maximum":27118.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19766.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15607.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19766.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24070.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19706.17},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27118.76},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21876.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9696.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15560.82,"maximum":43521.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31722.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25047.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31722.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38629.56},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31625.57},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43521.71},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35109.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15560.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7511.93,"maximum":21009.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15313.84},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12091.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15313.84},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18648.27},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15267.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21009.93},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16948.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7511.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7511.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8391.99,"10th_percentile":8391.99,"90th_percentile":8439.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":492.23,"10th_percentile":492.23,"90th_percentile":492.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":21332.38,"10th_percentile":21332.38,"90th_percentile":21332.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5537.48,"10th_percentile":5537.48,"90th_percentile":5537.48,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7339.97,"10th_percentile":7339.97,"90th_percentile":7339.97,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12764.3,"maximum":35700.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26021.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20545.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26021.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31687.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25941.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35700.17},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28799.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12764.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13117.29,"10th_percentile":13117.29,"90th_percentile":13117.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37905.28,"maximum":106016.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37905.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37905.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":77273.87},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61013.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":77273.87},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94099.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37905.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37905.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37905.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37905.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77038.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106016.4},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85524.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37905.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":37905.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22152.43,"maximum":61957.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22152.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22152.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45160.04},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35657.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45160.04},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54993.14},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22152.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22152.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22152.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22152.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45022.24},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61957.61},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49981.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22152.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22152.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21288.77,"10th_percentile":21288.77,"90th_percentile":21288.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6535.95,"10th_percentile":6535.95,"90th_percentile":6535.95,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20953.31,"maximum":58603.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42715.5},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33726.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42715.5},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52016.34},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42585.17},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58603.82},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47276.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc Or Insertion Of Antibiotic-Eluting Bone Void Fi","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20712.91,"maximum":57931.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42225.44},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33340.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42225.44},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51419.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42096.6},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57931.47},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46733.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20712.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20712.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22006.34,"10th_percentile":22006.34,"90th_percentile":22006.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7942.93,"maximum":22215.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16192.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12785.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16192.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19718.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16143.08},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22215.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17921.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7568.11,"maximum":21167.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15428.39},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12181.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15428.39},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18787.75},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15381.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21167.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17075.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7568.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8367.97,"10th_percentile":8367.97,"90th_percentile":8367.97,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8385.32,"10th_percentile":8385.32,"90th_percentile":8385.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":77.42,"10th_percentile":77.42,"90th_percentile":77.42,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7186.93,"10th_percentile":7186.93,"90th_percentile":7186.93,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":540.22,"10th_percentile":540.22,"90th_percentile":540.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4566.04,"maximum":12770.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9308.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7349.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9308.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11335.15},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9279.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12770.66},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10302.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4566.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5278.28,"10th_percentile":5278.28,"90th_percentile":5278.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7818.46,"maximum":21867.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15938.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12584.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15938.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19409.24},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15890.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21867.28},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17640.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7818.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7818.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":23646.77,"10th_percentile":23646.77,"90th_percentile":23646.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95213.12,"10th_percentile":95213.12,"90th_percentile":95213.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19549.36,"maximum":54677.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39853.4},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31467.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39853.4},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48531.05},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39731.8},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54677.14},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44108.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19549.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20607.78,"10th_percentile":20607.78,"90th_percentile":20607.78,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8283.28,"10th_percentile":8283.28,"90th_percentile":8283.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":48296.34,"10th_percentile":48296.34,"90th_percentile":48296.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7492.75,"10th_percentile":7492.75,"90th_percentile":7492.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6992.89,"10th_percentile":6992.89,"90th_percentile":6992.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20472.35,"10th_percentile":20472.35,"90th_percentile":20472.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":54609.75,"maximum":152736.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":111327.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":87901.18},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":111327.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":135568.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110987.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152736.74},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123213.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54609.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":54609.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":38851.92,"maximum":108664.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79203.69},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62536.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79203.69},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96449.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78962.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108664.03},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87659.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38851.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":38851.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12855.34,"maximum":35954.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26206.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20692.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26206.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31913.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26126.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35954.79},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29004.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12855.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12075.84,"maximum":33774.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24617.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19437.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24617.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29978.12},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24542.74},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33774.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27246.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12075.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12075.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":23759.08,"maximum":66451.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23759.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23759.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48435.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38243.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48435.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58981.63},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23759.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23759.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23759.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23759.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48287.57},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66451.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53606.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23759.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":23759.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10332.21,"10th_percentile":10332.21,"90th_percentile":10332.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18157.49,"maximum":50784.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37015.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29226.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37015.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45075.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36903.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50784.28},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40967.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18157.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11408.71,"maximum":31908.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23257.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18363.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23257.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28321.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23186.88},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31908.76},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25740.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11408.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11408.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9340.52,"10th_percentile":8770.31,"90th_percentile":12633.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12683.55,"10th_percentile":12683.55,"90th_percentile":12683.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":30716.29,"10th_percentile":23948.66,"90th_percentile":51801.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":35101.09,"10th_percentile":35101.09,"90th_percentile":35101.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5398.11,"10th_percentile":5398.11,"90th_percentile":5398.11,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24501.17,"10th_percentile":24501.17,"90th_percentile":24501.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11787.11,"10th_percentile":10688.02,"90th_percentile":12747.41,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19247.09,"maximum":53831.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19247.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19247.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39237.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30980.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39237.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47780.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19247.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19247.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19247.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19247.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39117.47},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53831.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43426.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19247.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19247.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":3236.77,"maximum":9052.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3236.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3236.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":6598.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":5209.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":6598.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8035.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3236.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3236.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3236.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3236.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6578.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9052.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7302.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3236.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":3236.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11207.43,"maximum":31345.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11207.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11207.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22847.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18039.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22847.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27822.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11207.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11207.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11207.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11207.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22777.81},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31345.81},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25286.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11207.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11207.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14830.4,"maximum":41478.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14830.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14830.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30233.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23871.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30233.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36816.29},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14830.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14830.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14830.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14830.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30141.07},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41478.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33461.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14830.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14830.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13118.9,"10th_percentile":13118.9,"90th_percentile":13118.9,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16552.01,"10th_percentile":16552.01,"90th_percentile":16552.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16508.68,"10th_percentile":16508.68,"90th_percentile":16508.68,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12538.84,"maximum":35069.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25561.74},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20182.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25561.74},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31127.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25483.74},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35069.6},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28290.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12538.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":45522.27,"10th_percentile":45522.27,"90th_percentile":45522.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":45981.69,"10th_percentile":42948.83,"90th_percentile":52659.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13354.84,"10th_percentile":13354.84,"90th_percentile":13354.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11683.4,"10th_percentile":11683.4,"90th_percentile":11683.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":25841.07,"10th_percentile":25841.07,"90th_percentile":25841.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17049.41,"maximum":47685.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17049.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17049.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34757.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27443.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34757.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42324.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17049.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17049.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17049.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17049.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34650.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47685.1},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38467.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17049.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17049.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":55547.2,"10th_percentile":55547.2,"90th_percentile":55547.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18055.1,"10th_percentile":18055.1,"90th_percentile":18055.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18003.49,"10th_percentile":18003.49,"90th_percentile":18003.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":39114.5,"10th_percentile":39114.5,"90th_percentile":40652.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10618.79,"10th_percentile":10618.79,"90th_percentile":10618.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10340.89,"10th_percentile":10340.89,"90th_percentile":10340.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20025.11,"10th_percentile":20025.11,"90th_percentile":20025.11,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18369.44,"maximum":51377.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18369.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18369.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37448.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29567.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37448.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45601.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18369.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18369.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18369.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18369.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37333.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51377.06},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41446.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18369.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18369.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8305.65,"maximum":23229.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8305.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8305.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16931.93},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13368.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16931.93},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20618.68},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8305.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8305.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8305.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8305.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16880.27},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23229.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18739.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8305.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8305.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17171.03,"maximum":48025.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35004.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27638.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35004.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42626.88},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34898.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48025.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38742.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17171.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8602.94,"maximum":24061.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17537.99},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13847.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17537.99},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21356.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17484.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24061.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19410.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8602.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7670.67,"10th_percentile":7670.67,"90th_percentile":7670.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9819.84,"maximum":27464.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20018.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15806.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20018.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24377.64},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19957.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27464.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22156.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9819.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9020.43,"maximum":25229.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18389.08},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14519.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18389.08},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22393.1},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18332.97},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25229.02},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20352.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9020.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":25463.61,"10th_percentile":25463.61,"90th_percentile":25463.61},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9997.31,"10th_percentile":9997.31,"90th_percentile":9997.31,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4719.91,"10th_percentile":4719.91,"90th_percentile":4719.91,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4464.36,"10th_percentile":4464.36,"90th_percentile":4464.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":68246.09,"10th_percentile":68246.09,"90th_percentile":68246.09,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":24416.87,"10th_percentile":24416.87,"90th_percentile":24416.87,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9999.55,"10th_percentile":9999.55,"90th_percentile":9999.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":28594.68,"maximum":79975.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28594.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28594.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58293.23},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46026.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58293.23},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70985.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28594.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28594.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28594.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28594.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58115.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79975.79},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64516.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28594.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":28594.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14953.44,"maximum":41822.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30484.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24069.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30484.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37121.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30391.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41822.93},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33738.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14953.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14953.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":24232.04,"maximum":67774.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24232.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24232.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49399.54},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39004.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49399.54},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60155.76},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24232.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24232.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24232.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24232.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49248.81},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67774.03},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54673.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24232.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":24232.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":39984.89,"maximum":111832.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81513.38},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64360.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81513.38},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99262.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81264.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111832.82},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90216.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":39984.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6068.86,"maximum":16973.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12372.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9768.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12372.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15065.86},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12334.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16973.84},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13692.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6068.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7783.61,"maximum":21769.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15867.71},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12528.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15867.71},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19322.73},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15819.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21769.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17561.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7783.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7783.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8549.57,"10th_percentile":8549.57,"90th_percentile":8549.57,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7902.33,"10th_percentile":7902.33,"90th_percentile":7902.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":12482.53,"10th_percentile":12482.53,"90th_percentile":12482.53,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection Without Cc/Mcc","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29676.44,"maximum":83001.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60498.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47767.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60498.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73671.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60313.93},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83001.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66957.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29676.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19544.38,"maximum":54663.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19544.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19544.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39843.25},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31459.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39843.25},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48518.69},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19544.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19544.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19544.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19544.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39721.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54663.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44097.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19544.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19544.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19839.95,"10th_percentile":19839.95,"90th_percentile":19839.95,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8393.84,"maximum":23476.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8393.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8393.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17111.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13510.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17111.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20837.61},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8393.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8393.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8393.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8393.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17059.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23476.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18938.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8393.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8393.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7809.21,"10th_percentile":7809.21,"90th_percentile":7809.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22951.84,"maximum":64193.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22951.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22951.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46789.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36943.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46789.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56977.68},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22951.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22951.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22951.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22951.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46646.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64193.47},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51785.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22951.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22951.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25786.77,"maximum":72122.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25786.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25786.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52569.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41507.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52569.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64015.36},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25786.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25786.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25786.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25786.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52408.62},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72122.42},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58181.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25786.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25786.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19850.91,"maximum":55520.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19850.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19850.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40468.16},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31952.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40468.16},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49279.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19850.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19850.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19850.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19850.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40344.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55520.56},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44788.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19850.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19850.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11773.57,"maximum":32929.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24001.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18951.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24001.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29227.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23928.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32929.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26564.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11773.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33590.77,"10th_percentile":33590.77,"90th_percentile":33590.77,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10624.94,"maximum":29716.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21660.06},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17102.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21660.06},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26376.3},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21593.97},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29716.66},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23972.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10624.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5122.93,"maximum":14328.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10443.63},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8245.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10443.63},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12717.62},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10411.76},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14328.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11558.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5122.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8203.23,"maximum":22943.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16723.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13204.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16723.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20364.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16672.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22943.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18508.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8203.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5903.85,"maximum":16512.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5903.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5903.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12035.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9502.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12035.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14656.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5903.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5903.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5903.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5903.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11998.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16512.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13320.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5903.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5903.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6641.95,"10th_percentile":6641.95,"90th_percentile":6641.95,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10133.49,"maximum":28342.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20658.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16311.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20658.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25156.27},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20595.14},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28342.12},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22863.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10133.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":46594.99,"maximum":130320.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":94988.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":75000.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":94988.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115671.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94698.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130320.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105130.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46594.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":46594.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10263.64,"maximum":28706.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20923.51},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16520.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20923.51},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25479.37},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20859.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28706.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23157.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10263.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15082.88,"maximum":42184.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30748.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24277.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30748.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37443.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30654.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42184.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34030.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15082.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15082.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6194.03,"maximum":17323.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12627.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9970.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12627.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15376.61},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12588.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17323.94},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13975.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6194.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6978.23,"10th_percentile":6978.23,"90th_percentile":6978.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6976.29,"10th_percentile":6976.29,"90th_percentile":6976.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":12770.72,"10th_percentile":12770.72,"90th_percentile":15316.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":12484.55,"10th_percentile":12484.55,"90th_percentile":12484.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":18416.01,"10th_percentile":18416.01,"90th_percentile":18416.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6986.88,"10th_percentile":6969.19,"90th_percentile":7022.57,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12731.75,"10th_percentile":12731.75,"90th_percentile":12731.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":9460.72,"10th_percentile":9460.72,"90th_percentile":9460.72,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6385.53,"10th_percentile":5305.04,"90th_percentile":7024.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13301.98,"maximum":37204.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13301.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13301.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27117.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21411.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27117.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33022.02},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13301.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13301.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13301.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13301.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27034.74},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37204.01},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30012.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13301.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13301.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14926.29,"10th_percentile":14926.29,"90th_percentile":14926.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14865.85,"10th_percentile":14865.85,"90th_percentile":14865.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":26392.06,"10th_percentile":26392.06,"90th_percentile":26392.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9333.33,"10th_percentile":9333.33,"90th_percentile":9333.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13196.66,"10th_percentile":13196.66,"90th_percentile":13196.66,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10711.43,"10th_percentile":10711.43,"90th_percentile":10711.43,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14967.3,"10th_percentile":14967.3,"90th_percentile":14967.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":21479.61,"maximum":60075.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21479.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21479.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43788.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34574.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43788.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53322.89},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21479.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21479.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21479.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21479.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43654.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60075.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48463.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21479.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":21479.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4418.11,"maximum":12356.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9006.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7111.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9006.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10967.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8979.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12356.91},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9968.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4418.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4430.04,"10th_percentile":4430.04,"90th_percentile":4430.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":26356.46,"maximum":73715.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26356.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26356.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53730.39},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42424.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53730.39},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65429.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26356.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26356.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26356.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26356.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53566.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73715.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59466.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26356.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":26356.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18071.44,"maximum":50543.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36840.51},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29088.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36840.51},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44862.13},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36728.1},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50543.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40773.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18071.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":125.0,"10th_percentile":125.0,"90th_percentile":125.0,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7867.54,"maximum":22004.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16038.79},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12663.78},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16038.79},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19531.07},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15989.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22004.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17751.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7867.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11674.0,"maximum":32650.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23798.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18790.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23798.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28980.56},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23726.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32650.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26339.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11674.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11674.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":46084.42,"10th_percentile":46084.42,"90th_percentile":46084.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5757.34,"maximum":16102.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5757.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5757.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11736.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9267.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11736.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14292.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5757.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5757.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5757.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5757.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11701.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16102.57},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12990.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5757.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5757.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":18625.67,"10th_percentile":18625.67,"90th_percentile":18625.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5891.39,"10th_percentile":4726.77,"90th_percentile":6445.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6463.4,"10th_percentile":6463.4,"90th_percentile":6463.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":15193.15,"10th_percentile":15193.15,"90th_percentile":15193.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":18915.3,"10th_percentile":18915.3,"90th_percentile":18915.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6423.44,"10th_percentile":6423.44,"90th_percentile":6423.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5657.14,"10th_percentile":5657.14,"90th_percentile":6507.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3843.78,"10th_percentile":3843.78,"90th_percentile":3843.78,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":12879.32,"10th_percentile":12879.32,"90th_percentile":12879.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":5659.71,"10th_percentile":197.78,"90th_percentile":6450.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6718.18,"10th_percentile":6718.18,"90th_percentile":6718.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9229.53,"maximum":25813.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18815.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14856.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18815.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22912.19},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18757.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25813.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20824.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9229.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19443.38,"maximum":54380.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39637.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31296.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39637.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48267.97},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39516.42},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54380.75},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43869.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19443.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19443.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20676.48,"10th_percentile":20676.48,"90th_percentile":20676.48,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8461.41,"maximum":23665.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17249.46},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13619.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17249.46},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21005.34},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17196.83},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23665.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19091.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8461.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14651.17,"maximum":40977.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29867.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23582.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29867.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36371.36},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29776.81},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40977.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33056.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14651.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10214.04,"10th_percentile":10214.04,"90th_percentile":10214.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4896.05,"maximum":13693.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9981.11},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7880.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9981.11},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12154.39},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9950.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13693.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11046.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4896.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4896.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5565.18,"10th_percentile":5565.18,"90th_percentile":5565.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9940.54,"10th_percentile":9940.54,"90th_percentile":9940.54,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5741.53,"10th_percentile":5741.53,"90th_percentile":5741.53,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11625.63,"maximum":32515.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23700.07},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18712.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23700.07},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28860.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23627.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32515.46},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26230.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11625.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11625.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13616.34,"maximum":38083.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13616.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13616.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27758.34},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21917.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27758.34},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33802.41},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13616.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13616.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13616.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13616.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27673.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38083.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30721.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13616.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13616.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9934.35,"maximum":27785.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9934.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9934.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20252.2},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15990.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20252.2},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24661.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9934.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9934.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9934.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9934.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20190.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27785.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22414.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9934.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9934.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":711.31,"10th_percentile":711.31,"90th_percentile":711.31,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13815.48,"maximum":38640.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28164.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22237.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28164.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34296.78},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28078.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38640.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31171.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":10270.48,"10th_percentile":142.22,"90th_percentile":15150.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":13426.66,"10th_percentile":3015.64,"90th_percentile":15042.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":27384.34,"10th_percentile":20158.7,"90th_percentile":58331.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":22462.12,"10th_percentile":18221.36,"90th_percentile":41861.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13103.22,"10th_percentile":13103.22,"90th_percentile":15182.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":9521.19,"10th_percentile":3625.13,"90th_percentile":15042.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14267.39,"10th_percentile":14267.39,"90th_percentile":14267.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9087.59,"10th_percentile":9087.59,"90th_percentile":9087.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":29414.16,"10th_percentile":29414.16,"90th_percentile":29414.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15467.77,"10th_percentile":15467.77,"90th_percentile":15467.77,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":37175.77,"10th_percentile":37175.77,"90th_percentile":37175.77,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":31485.82,"10th_percentile":31485.82,"90th_percentile":31485.82,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18381.47,"10th_percentile":18381.47,"90th_percentile":18381.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":12448.3,"10th_percentile":6390.87,"90th_percentile":15061.97,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16280.35,"10th_percentile":15774.3,"90th_percentile":16357.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7097.28,"maximum":19850.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14468.55},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11423.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14468.55},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17618.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14424.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19850.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16013.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7097.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7097.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":14203.86,"10th_percentile":14203.86,"90th_percentile":14203.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8107.82,"10th_percentile":8107.82,"90th_percentile":8107.82,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8046.27,"10th_percentile":8046.27,"90th_percentile":8046.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":61588.26,"maximum":172254.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":125554.09},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":99133.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":125554.09},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":152892.13},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125170.99},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172254.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138959.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":61588.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7186.19,"maximum":20098.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14649.79},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11567.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14649.79},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17839.62},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14605.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20098.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16213.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7186.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":39045.37,"maximum":109205.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79598.06},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62848.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79598.06},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96929.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79355.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109205.09},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88096.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":39045.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":33269.54,"maximum":93050.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":67823.42},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53551.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":67823.42},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82591.24},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67616.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93050.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75064.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":33269.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8244.48,"maximum":23058.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16807.24},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13270.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16807.24},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20466.84},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16755.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23058.81},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18601.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8244.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8244.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7443.65,"maximum":20818.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15174.65},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11981.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15174.65},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18478.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15128.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20818.97},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16794.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7443.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":28335.79,"maximum":79251.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57765.47},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45609.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":57765.47},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70343.27},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57589.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79251.72},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63932.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":28335.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10496.92,"maximum":29358.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21399.07},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16896.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21399.07},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26058.49},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21333.78},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29358.6},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23683.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10496.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10496.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":2733.97,"10th_percentile":2733.97,"90th_percentile":2733.97,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1529.14,"10th_percentile":1529.14,"90th_percentile":2190.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"20","median_amount":2403.03,"10th_percentile":1335.0,"90th_percentile":4167.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":1335.0,"10th_percentile":1335.0,"90th_percentile":1335.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4657.8,"10th_percentile":4657.8,"90th_percentile":4657.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":5434.28,"10th_percentile":5434.28,"90th_percentile":5434.28},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1554.28,"10th_percentile":1492.55,"90th_percentile":5010.43,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":636.0,"10th_percentile":624.13,"90th_percentile":1520.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4962.9,"10th_percentile":4962.9,"90th_percentile":4962.9,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1529.14,"10th_percentile":1529.14,"90th_percentile":1529.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":2724.0,"10th_percentile":2724.0,"90th_percentile":2724.0,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":3435.25,"10th_percentile":2864.72,"90th_percentile":3588.0,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1529.14,"10th_percentile":1529.14,"90th_percentile":2190.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11731.6,"maximum":32811.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23916.1},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18883.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23916.1},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29123.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23843.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32811.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26469.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11731.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":16691.0,"10th_percentile":16691.0,"90th_percentile":16691.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3765.49,"10th_percentile":3765.49,"90th_percentile":3765.49,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23357.45,"10th_percentile":23357.45,"90th_percentile":23357.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7621.45,"maximum":21316.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15537.13},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12267.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15537.13},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18920.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15489.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21316.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17195.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7621.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6029.55,"10th_percentile":6029.55,"90th_percentile":6029.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":8626.89,"10th_percentile":8626.89,"90th_percentile":9463.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":8433.0,"10th_percentile":8433.0,"90th_percentile":8433.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":5823.03,"10th_percentile":5823.03,"90th_percentile":5823.03},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2874.36,"10th_percentile":2874.36,"90th_percentile":2874.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13098.57,"maximum":36635.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26702.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21083.78},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26702.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32517.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26621.33},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36635.1},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29553.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13098.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13098.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8824.13,"maximum":24680.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17988.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14203.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17988.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21905.8},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17934.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24680.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19909.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8824.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8824.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":26091.11,"10th_percentile":26091.11,"90th_percentile":26091.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58754.29,"10th_percentile":58754.29,"90th_percentile":58754.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":18766.85,"10th_percentile":18766.85,"90th_percentile":18766.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9569.49,"maximum":26764.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19508.4},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15403.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19508.4},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23756.15},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19448.88},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26764.69},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21591.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9569.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4663.48,"maximum":13043.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9506.99},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7506.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9506.99},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11577.04},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9477.99},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13043.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10522.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4663.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4663.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10692.51,"maximum":29905.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21797.8},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17210.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21797.8},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26544.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21731.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29905.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24125.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10692.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10692.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10138.51,"10th_percentile":10138.51,"90th_percentile":10138.51,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7878.2,"maximum":22034.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16060.54},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12680.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16060.54},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19557.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16011.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22034.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17775.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7878.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80.52,"10th_percentile":80.52,"90th_percentile":80.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7697.86,"10th_percentile":7697.86,"90th_percentile":7697.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8444.7,"10th_percentile":8444.7,"90th_percentile":8444.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7697.87,"10th_percentile":7697.87,"90th_percentile":8881.11,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5093.77,"maximum":14246.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5093.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5093.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10384.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8199.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10384.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12645.23},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5093.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5093.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5093.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5093.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10352.5},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14246.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11492.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5093.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5093.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6693.31,"maximum":18720.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13645.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10773.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13645.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16616.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13603.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18720.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15101.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6693.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":222.58,"10th_percentile":222.58,"90th_percentile":222.58,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":46764.97,"maximum":130795.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":95335.27},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":75274.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":95335.27},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116093.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95044.38},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130795.87},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105513.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":93633.09,"10th_percentile":93633.09,"90th_percentile":93633.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49006.11,"10th_percentile":49006.11,"90th_percentile":49006.11,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":43118.54,"maximum":120597.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43118.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43118.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":87901.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69404.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":87901.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107041.27},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43118.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43118.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43118.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43118.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87633.43},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120597.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97286.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43118.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":43118.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22707.89,"maximum":63511.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46292.41},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36551.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46292.41},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56372.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46151.16},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63511.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51234.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22707.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12671.84,"maximum":35441.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25832.87},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20396.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25832.87},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31457.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25754.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35441.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28590.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12671.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11592.21,"maximum":32421.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23631.92},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18659.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23631.92},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28777.51},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23559.81},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32421.97},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26155.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11592.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11592.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":37526.2,"maximum":104956.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76501.07},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60403.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76501.07},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93158.35},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76267.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104956.16},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84668.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":37526.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39070.02,"10th_percentile":39070.02,"90th_percentile":39070.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":39588.03,"maximum":110722.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":80704.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63721.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":80704.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98276.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80458.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110722.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89320.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39588.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":39588.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15737.92,"maximum":44017.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15737.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15737.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32083.39},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25332.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32083.39},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39069.2},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15737.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15737.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15737.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15737.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31985.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44017.02},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35508.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15737.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15737.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16933.02,"10th_percentile":16933.02,"90th_percentile":16933.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16935.67,"10th_percentile":16935.67,"90th_percentile":16935.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16231.97,"10th_percentile":16231.97,"90th_percentile":16231.97,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17065.79,"10th_percentile":17065.79,"90th_percentile":17065.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":160.43,"10th_percentile":160.43,"90th_percentile":160.43,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11108.57,"maximum":31069.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22645.99},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17880.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22645.99},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27576.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22576.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31069.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25063.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11108.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12721.48,"10th_percentile":12721.48,"90th_percentile":12721.48,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8463.54,"maximum":23671.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8463.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8463.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17253.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13623.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17253.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21010.64},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8463.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8463.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8463.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8463.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17201.16},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23671.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19095.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8463.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8463.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9164.25,"10th_percentile":9164.25,"90th_percentile":9164.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6199.01,"maximum":17337.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12637.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9978.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12637.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15388.97},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12598.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17337.87},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13986.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6199.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6905.25,"10th_percentile":6905.25,"90th_percentile":6905.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1204.03,"10th_percentile":1204.03,"90th_percentile":1204.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6951.01,"10th_percentile":6898.25,"90th_percentile":6951.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17107.02,"maximum":47846.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34874.44},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27535.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34874.44},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42467.98},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34768.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47846.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38597.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11395.91,"maximum":31872.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23231.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18343.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23231.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28290.21},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23160.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31872.95},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25712.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11395.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":23104.16,"10th_percentile":23104.16,"90th_percentile":23104.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14997.54,"maximum":41946.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30574.04},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24140.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30574.04},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37231.21},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30480.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41946.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33838.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14997.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":55306.29,"10th_percentile":55306.29,"90th_percentile":55306.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16163.87,"10th_percentile":16163.87,"90th_percentile":16163.87,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17722.94,"maximum":49568.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17722.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17722.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36130.06},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28527.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36130.06},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43996.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17722.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17722.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17722.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17722.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36019.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49568.87},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39987.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17722.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17722.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9942.17,"maximum":27807.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20268.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16003.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20268.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24681.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20206.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27807.03},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22432.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9942.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5173.43,"maximum":14469.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5173.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5173.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10546.57},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8327.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10546.57},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12842.97},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5173.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5173.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5173.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5173.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10514.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14469.44},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11672.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5173.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5173.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7706.09,"maximum":21552.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15709.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12403.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15709.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19130.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15661.73},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21552.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17386.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7706.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5617.23,"maximum":15710.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11451.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9041.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11451.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13944.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11416.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15710.7},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12673.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5617.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4857.59,"10th_percentile":58.1,"90th_percentile":6384.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5849.18,"10th_percentile":5849.18,"90th_percentile":6405.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":11912.55,"10th_percentile":11912.55,"90th_percentile":11912.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":194.12,"10th_percentile":194.12,"90th_percentile":194.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4838.55,"10th_percentile":4838.55,"90th_percentile":4838.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6377.85,"10th_percentile":6377.85,"90th_percentile":6426.38,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7244.99,"10th_percentile":6962.37,"90th_percentile":7799.95,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10765.05,"maximum":30108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21945.69},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17327.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21945.69},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26724.12},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21878.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30108.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24288.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10765.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":41692.42,"10th_percentile":41692.42,"90th_percentile":41692.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11292.07,"maximum":31582.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23020.06},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18175.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23020.06},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28032.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22949.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31582.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25477.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11292.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12031.03,"maximum":33649.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24526.51},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19365.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24526.51},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29866.89},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24451.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33649.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27145.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12031.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12031.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":29945.8,"10th_percentile":29945.8,"90th_percentile":29945.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":54655.23,"10th_percentile":54655.23,"90th_percentile":54655.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":122.95,"10th_percentile":122.95,"90th_percentile":122.95,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13609.81,"10th_percentile":13609.81,"90th_percentile":13609.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78385.18,"maximum":219233.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":159796.38},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":126170.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":159796.38},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":194590.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159308.8},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219233.71},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176857.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78385.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":78385.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13063.01,"maximum":36535.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26630.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21026.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26630.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32428.78},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26549.06},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36535.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29473.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13063.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13063.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14070.7,"10th_percentile":14070.7,"90th_percentile":14070.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4976.42,"maximum":13918.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10144.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8010.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10144.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12353.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10114.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13918.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11228.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4976.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3934.63,"10th_percentile":3934.63,"90th_percentile":3934.63,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection With Mcc","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59766.82,"maximum":167160.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59766.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59766.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":121840.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":96202.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":121840.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":148370.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59766.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59766.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59766.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59766.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121469.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167160.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134849.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59766.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":59766.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":37021.94,"maximum":103545.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":75473.09},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59591.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":75473.09},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91906.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75242.81},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103545.82},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83531.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37021.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":37021.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc Or Insertion Of Antib","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30532.04,"maximum":85394.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30532.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30532.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62242.76},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49145.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62242.76},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75795.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30532.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30532.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30532.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30532.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62052.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85394.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68888.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30532.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":30532.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11600.03,"maximum":32443.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23647.87},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18671.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23647.87},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28796.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23575.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32443.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26172.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11600.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":33538.56,"10th_percentile":33538.56,"90th_percentile":33538.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11854.86,"10th_percentile":11854.86,"90th_percentile":11854.86,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":32550.51,"10th_percentile":32550.51,"90th_percentile":32550.51,"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":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18037.3,"maximum":50448.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18037.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18037.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36770.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29033.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36770.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44777.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18037.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18037.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18037.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18037.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36658.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50448.1},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40696.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18037.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18037.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12432.87,"maximum":34773.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25345.7},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20012.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25345.7},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30864.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25268.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34773.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28051.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12432.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":21482.46,"maximum":60083.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21482.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21482.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43794.23},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34578.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43794.23},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53329.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21482.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21482.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21482.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21482.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43660.6},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60083.79},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48469.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21482.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":21482.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":26580.49,"maximum":74342.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54187.11},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42784.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54187.11},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65985.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54021.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74342.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59972.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":26580.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5743.83,"maximum":16064.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11709.39},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9245.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11709.39},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14258.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11673.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16064.78},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12959.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5743.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4720.18,"10th_percentile":4720.18,"90th_percentile":4720.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4225.02,"10th_percentile":4225.02,"90th_percentile":4225.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5612.33,"10th_percentile":5612.33,"90th_percentile":5612.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40.48,"10th_percentile":40.48,"90th_percentile":40.48,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5366.88,"maximum":15010.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10940.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8638.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10940.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13323.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10907.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15010.5},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12109.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5366.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54.77,"10th_percentile":54.77,"90th_percentile":54.77,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6116.31,"10th_percentile":6116.31,"90th_percentile":6116.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":445.32,"10th_percentile":445.32,"90th_percentile":445.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6836.98,"maximum":19122.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13937.89},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11004.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13937.89},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16972.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13895.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19122.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15425.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6836.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7596.66,"10th_percentile":7596.66,"90th_percentile":7596.66,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":25351.2,"10th_percentile":25351.2,"90th_percentile":25351.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":194.87,"10th_percentile":194.87,"90th_percentile":194.87,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":532.4,"10th_percentile":532.4,"90th_percentile":532.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":236.54,"10th_percentile":209.48,"90th_percentile":5373.54,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9220.25,"10th_percentile":9220.25,"90th_percentile":9220.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8009.07,"maximum":22400.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16327.32},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12891.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16327.32},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19882.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16277.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22400.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18070.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8009.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":15302.46,"10th_percentile":15302.46,"90th_percentile":15302.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64.62,"10th_percentile":64.62,"90th_percentile":64.62,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12016.09,"maximum":33607.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24496.06},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19341.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24496.06},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29829.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24421.32},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33607.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27111.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12016.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":23032.92,"maximum":64420.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46955.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37074.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46955.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57178.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46811.74},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64420.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51968.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":23032.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8437.23,"maximum":23597.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17200.16},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13580.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17200.16},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20945.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17147.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23597.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19036.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8437.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8437.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8281.29,"10th_percentile":8281.29,"90th_percentile":8281.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4302.89,"maximum":12034.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4302.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4302.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8771.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":6926.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":8771.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10681.88},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4302.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4302.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4302.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4302.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8745.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12034.66},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9708.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4302.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4302.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9952.13,"maximum":27834.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20288.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16019.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20288.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24706.04},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20226.55},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27834.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22454.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9952.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12758.61,"maximum":35684.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26009.76},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20536.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26009.76},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31673.1},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25930.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35684.26},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28786.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12758.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12478.11,"10th_percentile":12478.11,"90th_percentile":12478.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10218.12,"maximum":28578.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20830.71},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16447.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20830.71},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25366.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20767.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28578.84},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23054.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10218.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":105.56,"10th_percentile":105.56,"90th_percentile":105.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5464.32,"maximum":15283.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11139.58},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8795.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11139.58},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13565.1},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11105.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15283.02},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12328.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5464.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13015.36,"maximum":36402.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26533.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20949.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26533.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32310.48},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26452.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36402.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29366.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13015.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":36131.14,"10th_percentile":36131.14,"90th_percentile":36131.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14181.65,"10th_percentile":14181.65,"90th_percentile":14181.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22198.66,"maximum":62086.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45254.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35731.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45254.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55107.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45116.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62086.91},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50085.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22198.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22198.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":29882.7,"maximum":83578.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60919.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48099.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60919.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74183.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60733.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83578.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67423.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29882.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29882.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7423.96,"10th_percentile":7423.96,"90th_percentile":7423.96,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31726.49,"10th_percentile":31726.49,"90th_percentile":31726.49,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5620.79,"maximum":15720.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11458.56},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9047.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11458.56},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13953.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11423.6},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15720.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12681.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5620.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11766.45,"maximum":32909.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23987.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18939.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23987.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29210.09},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23913.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32909.32},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26548.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11766.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13035.26,"10th_percentile":13035.26,"90th_percentile":13035.26,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12944.27,"10th_percentile":12944.27,"90th_percentile":12944.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7671.56,"10th_percentile":7671.56,"90th_percentile":7671.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10871.14,"10th_percentile":10871.14,"90th_percentile":10871.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9854.63,"10th_percentile":9854.63,"90th_percentile":9854.63,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12506.82,"10th_percentile":12506.82,"90th_percentile":12506.82,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17485.39,"maximum":48904.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35645.79},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28144.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35645.79},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43407.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35537.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48904.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39451.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17485.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12552.26,"10th_percentile":12552.26,"90th_percentile":12552.26,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8756.71,"10th_percentile":8756.71,"90th_percentile":8756.71,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18384.7,"10th_percentile":18384.7,"90th_percentile":18384.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6689.04,"maximum":18708.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13636.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10766.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13636.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16605.47},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13594.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18708.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15092.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6689.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7294.46,"10th_percentile":7294.46,"90th_percentile":7294.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":3954.39,"maximum":11059.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3954.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3954.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8061.44},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":6365.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":8061.44},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9816.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3954.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3954.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3954.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3954.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8036.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11059.95},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8922.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3954.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":3954.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2393.86,"10th_percentile":2393.86,"90th_percentile":2393.86,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":16759.06,"10th_percentile":16759.06,"90th_percentile":16759.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3520.86,"10th_percentile":3520.86,"90th_percentile":3520.86,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4639.23,"10th_percentile":4639.23,"90th_percentile":4639.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4660.6,"10th_percentile":4141.17,"90th_percentile":4667.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16620.54,"maximum":46485.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33882.71},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26752.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33882.71},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41260.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33779.33},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46485.61},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37500.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16620.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7238.1,"maximum":20244.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14755.63},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11650.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14755.63},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17968.51},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14710.61},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20244.09},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16331.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7238.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7238.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11959.91,"maximum":33450.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24381.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19250.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24381.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29690.33},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24307.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33450.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26984.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11959.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":26123.89,"maximum":73065.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53256.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42049.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53256.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64852.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53093.78},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73065.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58942.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":26123.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7616.48,"maximum":21302.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15526.98},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12259.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15526.98},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18907.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15479.6},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21302.34},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17184.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7616.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7616.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":27488.01,"maximum":76880.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27488.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27488.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56037.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44245.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56037.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68238.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27488.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27488.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27488.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27488.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55866.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76880.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62020.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27488.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":27488.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10656.24,"maximum":29804.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21723.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17152.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21723.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26453.98},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21657.57},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29804.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24043.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10656.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":19266.92,"10th_percentile":19266.92,"90th_percentile":19266.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14210.92,"maximum":39746.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28970.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22874.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28970.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35278.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28882.06},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39746.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32063.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14210.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15299.99,"10th_percentile":15299.99,"90th_percentile":15299.99,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12240.11,"10th_percentile":12240.11,"90th_percentile":12240.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13986.73,"10th_percentile":13986.73,"90th_percentile":13986.73,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15593.16,"10th_percentile":15593.16,"90th_percentile":15593.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":144.83,"10th_percentile":144.83,"90th_percentile":144.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4623.57,"10th_percentile":4623.57,"90th_percentile":4623.57,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14814.63,"10th_percentile":14814.63,"90th_percentile":14814.63,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8658.42,"maximum":24216.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17651.08},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13936.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17651.08},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21494.41},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17597.22},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24216.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19535.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8658.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8658.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":57176.3,"10th_percentile":57176.3,"90th_percentile":57176.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8673.35,"maximum":24258.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17681.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13960.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17681.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21531.49},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17627.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24258.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19569.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8673.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12117.8,"maximum":33891.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24703.4},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19505.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24703.4},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30082.29},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24628.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33891.99},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27340.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12117.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12117.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":41711.74,"maximum":116662.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85033.74},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67140.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85033.74},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103548.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84774.28},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116662.6},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94112.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":41711.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6530.44,"maximum":18264.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13312.98},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10511.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13312.98},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16211.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13272.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18264.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14734.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6530.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6530.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7278.31,"10th_percentile":7278.31,"90th_percentile":7278.31,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":13276.88,"10th_percentile":13276.88,"90th_percentile":13276.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3203.39,"10th_percentile":3203.39,"90th_percentile":3203.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18477.09,"10th_percentile":18477.09,"90th_percentile":18477.09,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":328.99,"10th_percentile":328.99,"90th_percentile":7339.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9644.17,"maximum":26973.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19660.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15523.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19660.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23941.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19600.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26973.55},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21759.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9644.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8299.96,"maximum":23213.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16920.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13359.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16920.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20604.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16868.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23213.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18726.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8299.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8299.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":5847.29,"10th_percentile":5847.29,"90th_percentile":5847.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6819.2,"maximum":19072.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13901.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10976.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13901.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16928.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13859.22},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19072.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15385.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6819.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6819.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":57113.23,"10th_percentile":57113.23,"90th_percentile":57113.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":127.29,"10th_percentile":127.29,"90th_percentile":127.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4430.9,"10th_percentile":4430.9,"90th_percentile":4430.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"22","median_amount":16691.0,"10th_percentile":15732.39,"90th_percentile":16758.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":14056.0,"10th_percentile":14056.0,"90th_percentile":14056.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4430.9,"10th_percentile":4430.9,"90th_percentile":4430.9,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":26812.91,"10th_percentile":26812.91,"90th_percentile":26812.91},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4475.07,"10th_percentile":4475.07,"90th_percentile":4475.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"17","median_amount":3868.82,"10th_percentile":3482.13,"90th_percentile":6390.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21489.02,"10th_percentile":20030.84,"90th_percentile":40206.51,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4430.9,"10th_percentile":4430.9,"90th_percentile":4430.9,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19336.0,"10th_percentile":19336.0,"90th_percentile":19636.0,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":17070.0,"10th_percentile":15693.82,"90th_percentile":23344.0,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4430.9,"10th_percentile":4430.9,"90th_percentile":4430.9,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"1 through 10","median_amount":20930.08,"10th_percentile":20930.08,"90th_percentile":20930.08}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7131.42,"maximum":19945.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14538.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11478.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14538.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17703.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14493.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19945.71},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16090.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7131.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6831.29,"maximum":19106.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13926.29},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10995.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13926.29},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16958.59},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13883.8},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19106.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15413.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6831.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8090.15,"maximum":22627.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16492.61},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13022.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16492.61},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20083.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16442.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22627.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18253.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8090.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14655.44,"maximum":40989.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29876.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23589.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29876.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36381.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29785.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40989.46},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33066.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14655.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5135.02,"maximum":14362.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10468.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8265.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10468.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12747.63},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10436.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14362.02},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11585.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5135.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5946.59,"10th_percentile":5946.59,"90th_percentile":5946.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5015.68,"10th_percentile":5015.68,"90th_percentile":5015.68,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Male Reproductive System And Other O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15912.17,"maximum":44504.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32438.61},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25612.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32438.61},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39501.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32339.63},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44504.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35901.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15912.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15912.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14226.57,"maximum":39789.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29002.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22899.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29002.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35317.3},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28913.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39789.97},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32098.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14226.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7034.7,"maximum":19675.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14340.96},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11323.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14340.96},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17463.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14297.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19675.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15872.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7034.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7587.75,"10th_percentile":7587.75,"90th_percentile":7587.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4470.03,"maximum":12502.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9112.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7195.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9112.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11096.8},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9084.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12502.12},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10085.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4470.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":492.23,"10th_percentile":492.23,"90th_percentile":492.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5065.84,"10th_percentile":5065.84,"90th_percentile":5065.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4765.19,"maximum":13327.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9714.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7670.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9714.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11829.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9684.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13327.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10751.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4765.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":40588.72,"maximum":113521.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40588.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40588.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":82744.34},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65332.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":82744.34},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100761.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40588.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40588.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40588.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40588.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82491.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113521.65},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91578.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40588.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":40588.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":35186.99,"maximum":98413.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71732.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56637.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":71732.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87351.29},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71513.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98413.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79390.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":35186.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":72440.85,"10th_percentile":72440.85,"90th_percentile":72440.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38667.4,"10th_percentile":38667.4,"90th_percentile":38667.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36276.24,"10th_percentile":36276.24,"90th_percentile":36276.24,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37768.75,"10th_percentile":37768.75,"90th_percentile":37768.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":35004.21,"maximum":97902.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71359.73},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56343.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":71359.73},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86897.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71141.99},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97902.46},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78978.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35004.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":35004.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10629.21,"maximum":29728.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21668.76},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17109.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21668.76},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26386.89},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21602.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29728.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23982.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10629.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12073.66,"10th_percentile":12073.66,"90th_percentile":12073.66,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11837.59,"10th_percentile":11837.59,"90th_percentile":11837.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14381.62,"maximum":40223.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29318.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23149.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29318.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35702.2},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29228.97},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40223.61},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32448.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14381.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":33859.85,"maximum":94701.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33859.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33859.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69026.84},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54501.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69026.84},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84056.68},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33859.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33859.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33859.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33859.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68816.22},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94701.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76396.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33859.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":33859.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":50712.96,"maximum":141837.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50712.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50712.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":103383.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":81628.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":103383.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":125894.34},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50712.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50712.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50712.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50712.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103068.22},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141837.92},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114421.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50712.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":50712.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14087.88,"maximum":39402.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14087.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14087.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28719.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22676.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28719.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34973.0},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14087.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14087.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14087.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14087.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28631.99},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39402.07},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31785.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14087.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14087.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15061.79,"10th_percentile":15061.79,"90th_percentile":15061.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9130.67,"maximum":25537.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18613.82},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14696.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18613.82},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22666.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18557.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25537.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20601.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9130.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9130.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":6504.64,"10th_percentile":1022.96,"90th_percentile":8921.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9872.97,"10th_percentile":4695.51,"90th_percentile":10213.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":17412.84,"10th_percentile":17412.84,"90th_percentile":17412.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8921.65,"10th_percentile":8921.65,"90th_percentile":8921.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":9213.85,"10th_percentile":6863.65,"90th_percentile":10183.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7921.01,"10th_percentile":7921.01,"90th_percentile":7921.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6139.76,"10th_percentile":6139.76,"90th_percentile":6754.69,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":8552.17,"10th_percentile":6741.15,"90th_percentile":10213.88,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10536.34,"10th_percentile":10523.53,"90th_percentile":11363.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5118.66,"maximum":14316.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5118.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5118.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10434.93},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8239.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10434.93},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12707.02},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5118.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5118.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5118.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5118.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10403.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14316.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11549.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5118.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5118.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5232.46,"maximum":14634.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5232.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5232.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10666.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8422.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10666.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12989.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5232.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5232.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5232.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5232.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10634.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14634.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11805.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5232.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5232.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3573.77,"10th_percentile":3573.77,"90th_percentile":3573.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5963.56,"10th_percentile":5963.56,"90th_percentile":5963.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5918.5,"10th_percentile":5918.5,"90th_percentile":5918.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5912.7,"10th_percentile":4604.15,"90th_percentile":5972.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":47555.85,"maximum":133007.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47555.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47555.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":96947.56},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":76547.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":96947.56},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118056.84},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47555.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47555.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47555.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47555.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96651.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133007.86},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107298.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47555.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":47555.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22833.07,"maximum":63861.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22833.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22833.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46547.59},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36752.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46547.59},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56682.82},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22833.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22833.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22833.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22833.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46405.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63861.28},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51517.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22833.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22833.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16658.24,"maximum":46591.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33959.56},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26813.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33959.56},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41353.88},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33855.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46591.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37585.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16658.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16326.81,"maximum":45664.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33283.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26280.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33283.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40531.11},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33182.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45664.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36837.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16326.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16326.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9565.93,"maximum":26754.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19501.16},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15397.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19501.16},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23747.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19441.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26754.74},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21583.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9565.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9057.85,"10th_percentile":9057.85,"90th_percentile":10094.42,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10346.93,"10th_percentile":10346.93,"90th_percentile":10346.93,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4984.24,"maximum":13940.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4984.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4984.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10160.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8022.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10160.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12373.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4984.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4984.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4984.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4984.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10129.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13940.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11245.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4984.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4984.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6974.95,"maximum":19508.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14219.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11227.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14219.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17315.24},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14175.78},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19508.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15737.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6974.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7775.24,"10th_percentile":6939.83,"90th_percentile":7819.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7753.97,"10th_percentile":7753.97,"90th_percentile":7753.97,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":19737.47,"10th_percentile":19737.47,"90th_percentile":19737.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":25610.02,"10th_percentile":25610.02,"90th_percentile":25610.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7227.54,"10th_percentile":7227.54,"90th_percentile":7227.54,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7501.74,"10th_percentile":5493.53,"90th_percentile":7782.69,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":15737.29,"10th_percentile":15737.29,"90th_percentile":15737.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5478.34,"10th_percentile":333.56,"90th_percentile":7813.58,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6943.66,"maximum":19420.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14155.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11176.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14155.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17237.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14112.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19420.56},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15666.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6943.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6943.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6791.63,"10th_percentile":6791.63,"90th_percentile":6791.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":15939.67,"10th_percentile":15939.67,"90th_percentile":15939.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":12743.16,"10th_percentile":12743.16,"90th_percentile":12743.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7879.07,"10th_percentile":7879.07,"90th_percentile":7879.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6654.9,"maximum":18612.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13566.71},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10711.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13566.71},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16520.72},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13525.32},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18612.94},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15015.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6654.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1824.53,"10th_percentile":1824.53,"90th_percentile":1824.53,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":25431.45,"10th_percentile":25431.45,"90th_percentile":32144.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":890.13,"10th_percentile":890.13,"90th_percentile":890.13,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7629.09,"10th_percentile":7629.09,"90th_percentile":7629.09,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13927.72,"10th_percentile":13927.72,"90th_percentile":13927.72,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6714.48,"10th_percentile":6714.48,"90th_percentile":6714.48,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15786.28,"maximum":44152.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32181.98},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25409.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32181.98},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39189.26},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32083.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44152.28},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35617.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15786.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14698.82,"maximum":41110.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29965.08},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23659.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29965.08},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36489.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29873.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41110.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33164.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14698.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":29537.04,"maximum":82611.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60214.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47543.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60214.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73325.37},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60030.62},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82611.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66643.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29537.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":29537.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13998.27,"maximum":39151.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28536.93},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22531.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28536.93},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34750.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28449.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39151.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31583.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13998.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6064.63,"10th_percentile":6064.63,"90th_percentile":6064.63,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":64014.26,"10th_percentile":64014.26,"90th_percentile":64014.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27742.61,"10th_percentile":27742.61,"90th_percentile":27742.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15138.69,"10th_percentile":15138.69,"90th_percentile":15138.69,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4419.53,"maximum":12360.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9009.68},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7113.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9009.68},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10971.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8982.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12360.89},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9971.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4419.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5090.6,"10th_percentile":5090.6,"90th_percentile":5090.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4132.01,"10th_percentile":4132.01,"90th_percentile":4132.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":164.36,"10th_percentile":164.36,"90th_percentile":164.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":24048.91,"10th_percentile":24048.91,"90th_percentile":24048.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":4132.01,"10th_percentile":4132.01,"90th_percentile":4132.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15606.81,"10th_percentile":15606.81,"90th_percentile":15606.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":30161.5,"maximum":84357.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30161.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30161.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61487.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48548.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61487.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74875.56},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30161.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30161.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30161.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30161.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61299.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84357.99},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68052.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30161.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":30161.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40536.09,"maximum":113374.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":82637.05},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65247.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":82637.05},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100630.37},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82384.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113374.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91459.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":40536.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":34342.77,"maximum":96052.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34342.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34342.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70011.32},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55278.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":70011.32},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85255.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34342.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34342.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34342.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34342.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69797.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96052.5},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77486.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34342.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":34342.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13220.9,"maximum":36977.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26952.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21280.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26952.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32820.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26869.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36977.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29829.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12580.8,"maximum":35186.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25647.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20250.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25647.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31231.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25569.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35186.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28385.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12580.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12580.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":21456.14,"maximum":60010.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21456.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21456.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43740.58},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34536.33},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43740.58},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53264.62},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21456.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21456.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21456.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21456.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43607.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60010.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48410.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21456.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":21456.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9595.81,"maximum":26838.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19562.05},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15445.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19562.05},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23821.48},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19502.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26838.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21650.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9595.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22665.93,"maximum":63393.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46206.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36483.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46206.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56267.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46065.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63393.81},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51140.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22665.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11149.83,"maximum":31184.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22730.08},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17947.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22730.08},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27679.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22660.73},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31184.69},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25156.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11149.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11149.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5600.16,"maximum":15662.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11416.51},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9014.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11416.51},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13902.33},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11381.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15662.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12635.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5600.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8585.87,"maximum":24013.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17503.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13820.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17503.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21314.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17449.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24013.62},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19371.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8585.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10575.16,"maximum":29577.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10575.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10575.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21558.56},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17022.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21558.56},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26252.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10575.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10575.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10575.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10575.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21492.78},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29577.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23860.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10575.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10575.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5965.79,"10th_percentile":5965.79,"90th_percentile":5965.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6930.15,"maximum":19382.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14127.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11154.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14127.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17204.01},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14084.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19382.76},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15636.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6930.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8198.16,"10th_percentile":8198.16,"90th_percentile":8198.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4184.3,"10th_percentile":4184.3,"90th_percentile":4184.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3243.88,"10th_percentile":3243.88,"90th_percentile":6183.43,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":34858.41,"maximum":97494.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34858.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34858.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71062.5},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56108.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":71062.5},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86535.59},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34858.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34858.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34858.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34858.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70845.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97494.67},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78649.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34858.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":34858.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15225.13,"maximum":42582.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31038.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24506.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31038.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37796.2},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30943.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42582.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34351.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15225.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8046.05,"maximum":22503.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16402.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12951.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16402.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19974.23},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16352.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22503.82},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18153.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8046.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8046.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10762.21,"maximum":30100.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21939.89},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17323.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21939.89},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26717.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21872.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30100.57},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24282.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10762.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10762.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11381.68,"maximum":31833.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23202.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18320.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23202.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28254.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23131.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31833.17},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25680.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11381.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc Or Insertion Of Antibiotic-Eluti","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26505.82,"maximum":74133.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54034.87},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42664.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54034.87},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65800.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53870.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74133.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59803.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":26505.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10114.29,"maximum":28288.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20619.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16280.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20619.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25108.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20556.11},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28288.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22820.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10114.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10114.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19909.23,"maximum":55683.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40587.05},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32046.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40587.05},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49424.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40463.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55683.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44920.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19909.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19909.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":21774.06,"maximum":60899.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44388.69},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35048.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44388.69},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54053.84},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44253.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60899.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49127.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21774.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":21774.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6950.77,"maximum":19440.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14169.87},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11188.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14169.87},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17255.21},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14126.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19440.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15682.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6950.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4269.46,"maximum":11941.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8703.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":6872.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":8703.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10598.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8677.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11941.17},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9633.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4269.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4269.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4388.88,"10th_percentile":4388.88,"90th_percentile":4388.88,"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":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8134.96,"maximum":22752.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16583.96},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13094.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16583.96},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20194.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16533.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22752.47},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18354.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8134.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11689.64,"maximum":32694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11689.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11689.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23830.56},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18815.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23830.56},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29019.4},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11689.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11689.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11689.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11689.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23757.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32694.49},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26374.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11689.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11689.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20525.86,"maximum":57408.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41844.11},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33038.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41844.11},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50955.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41716.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57408.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46311.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20525.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7550.63,"10th_percentile":7550.63,"90th_percentile":7550.63,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":54194.4,"maximum":151575.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":110480.93},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":87232.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":110480.93},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134536.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110143.83},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151575.05},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122276.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":54194.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8156.29,"maximum":22812.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16627.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13128.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16627.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20247.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16576.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22812.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18402.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8156.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8156.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22907.03,"maximum":64068.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46698.38},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36871.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46698.38},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56866.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46555.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64068.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51684.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22907.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6095.88,"maximum":17049.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12427.09},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9812.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12427.09},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15132.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12389.17},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17049.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13753.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6095.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6095.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7082.14,"10th_percentile":7082.14,"90th_percentile":7082.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6939.16,"10th_percentile":6939.16,"90th_percentile":6939.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":11792.96,"10th_percentile":11792.96,"90th_percentile":11792.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6429.14,"10th_percentile":6429.14,"90th_percentile":6429.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5453.06,"10th_percentile":5453.06,"90th_percentile":5453.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6604.52,"10th_percentile":6604.52,"90th_percentile":6604.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5414.84,"10th_percentile":5414.84,"90th_percentile":5414.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":27305.94,"maximum":76371.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55666.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43952.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55666.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67786.68},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55496.16},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76371.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61609.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":27305.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14817.58,"10th_percentile":14817.58,"90th_percentile":14817.58,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":45438.48,"10th_percentile":45438.48,"90th_percentile":45438.48,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12411.53,"maximum":34713.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25302.2},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19977.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25302.2},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30811.49},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25225.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34713.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28003.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12411.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":441.97,"10th_percentile":441.97,"90th_percentile":441.97,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7679.92,"10th_percentile":7679.92,"90th_percentile":7679.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":17644.01,"10th_percentile":17644.01,"90th_percentile":28576.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7637.1,"maximum":21360.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15569.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12292.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15569.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18959.01},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15521.52},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21360.03},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17231.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7637.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7333.41,"maximum":20510.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14949.92},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11804.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14949.92},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18205.1},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14904.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20510.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16546.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7333.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":11148.61,"10th_percentile":11148.61,"90th_percentile":11148.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15230.82,"maximum":42598.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31049.61},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24515.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31049.61},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37810.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30954.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42598.72},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34364.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15230.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9304.2,"maximum":26022.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18967.59},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14976.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18967.59},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23097.58},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18909.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26022.71},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20992.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9304.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10269.33,"maximum":28722.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10269.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10269.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20935.11},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16529.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20935.11},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25493.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10269.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10269.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10269.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10269.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20871.23},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28722.06},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23170.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10269.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10269.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8552.44,"maximum":23920.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17435.05},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13766.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17435.05},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21231.34},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17381.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23920.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19296.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8552.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":32608.1,"maximum":91200.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32608.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32608.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":66475.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52486.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":66475.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80949.23},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32608.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32608.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32608.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32608.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66272.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91200.84},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73572.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32608.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":32608.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63178.54,"10th_percentile":63178.54,"90th_percentile":63178.54,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7211.79,"maximum":20170.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14701.99},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11608.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14701.99},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17903.18},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14657.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20170.49},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16271.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7211.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7106.35,"10th_percentile":7106.35,"90th_percentile":7106.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":31295.88,"10th_percentile":31295.88,"90th_percentile":31295.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4795.06,"maximum":13411.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9775.23},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7718.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9775.23},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11903.68},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9745.4},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13411.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10818.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4795.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":6489.13,"10th_percentile":4593.37,"90th_percentile":9057.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2632.99,"10th_percentile":2632.99,"90th_percentile":2985.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"53","median_amount":9290.49,"10th_percentile":7476.8,"90th_percentile":9373.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"13","median_amount":8432.78,"10th_percentile":5950.0,"90th_percentile":8433.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2636.28,"10th_percentile":2636.28,"90th_percentile":2636.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":20020.19,"10th_percentile":19866.32,"90th_percentile":27241.98},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2636.28,"10th_percentile":2636.28,"90th_percentile":2636.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":15545.98,"10th_percentile":15545.98,"90th_percentile":15545.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2636.28,"10th_percentile":2636.28,"90th_percentile":2636.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2636.28,"10th_percentile":2632.99,"90th_percentile":2636.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"41","median_amount":2461.64,"10th_percentile":2057.42,"90th_percentile":2913.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9182.28,"10th_percentile":5449.9,"90th_percentile":21871.69,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2632.99,"10th_percentile":2632.99,"90th_percentile":2636.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":9608.26,"10th_percentile":9608.26,"90th_percentile":9608.26,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"11","median_amount":8400.8,"10th_percentile":6069.53,"90th_percentile":10501.0,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2632.99,"10th_percentile":2632.99,"90th_percentile":3583.05,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5357.55,"10th_percentile":5357.55,"90th_percentile":5357.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":32210.53,"maximum":90088.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65664.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51846.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65664.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79962.26},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65464.16},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90088.88},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72675.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":32210.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":28868.5,"maximum":80741.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58851.44},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46467.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58851.44},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71665.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58671.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80741.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65134.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":4620.88,"10th_percentile":4620.88,"90th_percentile":4620.88,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1066.43,"10th_percentile":1066.43,"90th_percentile":1066.43,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":90.0,"10th_percentile":90.0,"90th_percentile":90.0,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17461.21,"maximum":48836.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35596.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28105.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35596.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43347.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35487.88},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48836.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39396.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17461.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4099.17,"10th_percentile":4099.17,"90th_percentile":4099.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4719.67,"maximum":13200.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4719.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4719.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9621.54},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7596.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9621.54},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11716.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4719.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4719.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4719.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4719.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9592.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13200.33},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10648.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4719.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4719.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9866.78,"maximum":27596.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20114.46},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15881.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20114.46},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24494.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20053.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27596.17},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22262.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9866.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12870.27,"maximum":35996.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26237.39},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20716.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26237.39},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31950.3},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26157.33},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35996.56},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29038.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12870.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7529.71,"maximum":21059.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15350.09},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12120.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15350.09},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18692.41},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15303.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21059.66},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16988.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7529.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7529.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9552.42,"maximum":26716.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19473.61},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15375.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19473.61},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23713.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19414.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26716.95},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21552.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9552.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9965.64,"maximum":27872.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20316.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16040.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20316.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24739.59},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20254.01},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27872.67},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22485.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9965.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10880.98,"maximum":30432.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22182.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17514.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22182.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27011.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22114.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30432.77},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24550.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10880.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12341.5,"10th_percentile":12341.5,"90th_percentile":12341.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10631.9,"10th_percentile":10631.9,"90th_percentile":10631.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":27467.09,"10th_percentile":27467.09,"90th_percentile":27467.09,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5995.6,"maximum":16768.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5995.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5995.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12222.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9650.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12222.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14884.01},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5995.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5995.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5995.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5995.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12185.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16768.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13527.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5995.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5995.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":596.96,"10th_percentile":596.96,"90th_percentile":596.96,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5216.71,"10th_percentile":5216.71,"90th_percentile":5216.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6920.13,"10th_percentile":6920.13,"90th_percentile":6920.13,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12546.67,"maximum":35091.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12546.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12546.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25577.69},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20195.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25577.69},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31146.95},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12546.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12546.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12546.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12546.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25499.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35091.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28308.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12546.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12546.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12935.58,"10th_percentile":12935.58,"90th_percentile":12935.58,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":45764.99,"maximum":127999.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":93296.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73664.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":93296.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113611.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93012.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127999.05},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103257.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45764.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":45764.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47089.81,"10th_percentile":47089.81,"90th_percentile":47089.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":46764.97,"maximum":130795.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":95335.27},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":75274.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":95335.27},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116093.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95044.38},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130795.87},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105513.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":46764.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":54374.33,"maximum":152078.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":110847.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":87522.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":110847.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134983.65},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110509.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152078.32},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122682.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":54374.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15155.43,"maximum":42387.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30895.92},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24394.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30895.92},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37623.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30801.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42387.86},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34194.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15155.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14815.5,"10th_percentile":14815.5,"90th_percentile":14815.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19184.5,"maximum":53656.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19184.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19184.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39109.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30879.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39109.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47625.29},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19184.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19184.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19184.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19184.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38990.27},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53656.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43285.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19184.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19184.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":21744.9,"maximum":60817.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21744.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21744.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44329.24},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35001.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44329.24},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53981.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21744.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21744.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21744.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21744.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44193.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60817.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49062.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21744.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":21744.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25293.18,"maximum":70741.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25293.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25293.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51562.79},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40712.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51562.79},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62790.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25293.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25293.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25293.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25293.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51405.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70741.92},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57067.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25293.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25293.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25649.51,"maximum":71738.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25649.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25649.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52289.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41286.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52289.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63674.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25649.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25649.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25649.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25649.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52129.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71738.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57871.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25649.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25649.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7610.79,"maximum":21286.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15515.38},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12250.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15515.38},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18893.69},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15468.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21286.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17171.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7610.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8299.65,"10th_percentile":8299.65,"90th_percentile":8299.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8603.65,"10th_percentile":8603.65,"90th_percentile":8603.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":21527.89,"10th_percentile":21527.89,"90th_percentile":21527.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7526.29,"10th_percentile":7526.29,"90th_percentile":7526.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6980.48,"10th_percentile":6980.48,"90th_percentile":8538.64,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8570.51,"10th_percentile":8570.51,"90th_percentile":8570.51,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":17857.87,"10th_percentile":17857.87,"90th_percentile":17857.87,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":17486.42,"10th_percentile":17486.42,"90th_percentile":17486.42,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8473.09,"10th_percentile":8473.09,"90th_percentile":8473.09,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4509.15,"maximum":12611.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9192.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7258.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9192.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11193.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9164.32},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12611.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10173.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4509.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5370.44,"maximum":15020.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5370.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5370.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10948.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8644.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10948.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13332.05},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5370.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5370.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5370.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5370.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10914.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15020.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12117.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5370.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5370.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5120.8,"maximum":14322.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10439.28},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8242.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10439.28},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12712.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10407.43},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14322.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11553.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5120.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51.71,"10th_percentile":51.71,"90th_percentile":51.71,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19350.92,"maximum":54122.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39448.88},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31147.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39448.88},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48038.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39328.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54122.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43660.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19350.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21820.24,"10th_percentile":21820.24,"90th_percentile":21820.24,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19989.36,"10th_percentile":19989.36,"90th_percentile":19989.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":25981.72,"10th_percentile":25981.72,"90th_percentile":25981.72,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":32691.31,"maximum":91433.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32691.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32691.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":66644.65},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52620.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":66644.65},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81155.8},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32691.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32691.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32691.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32691.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66441.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91433.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73760.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32691.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":32691.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":2603.63,"10th_percentile":2603.63,"90th_percentile":2603.63,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33428.88,"10th_percentile":10231.59,"90th_percentile":34687.38,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":64347.96,"10th_percentile":64347.96,"90th_percentile":64347.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":71771.78,"10th_percentile":71771.78,"90th_percentile":71771.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34679.51,"10th_percentile":34679.51,"90th_percentile":34679.51,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34677.19,"10th_percentile":34677.19,"90th_percentile":34677.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":20622.01,"10th_percentile":20622.01,"90th_percentile":20622.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":20622.01,"10th_percentile":20622.01,"90th_percentile":20622.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34767.52,"10th_percentile":34767.52,"90th_percentile":34767.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10917.26,"maximum":30534.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22255.97},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17572.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22255.97},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27101.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22188.06},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30534.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24632.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10917.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11963.07,"10th_percentile":11963.07,"90th_percentile":11963.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10842.58,"maximum":30325.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22103.73},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17452.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22103.73},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26916.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22036.28},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30325.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24463.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10842.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11628.43,"10th_percentile":11628.43,"90th_percentile":11628.43,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11625.89,"10th_percentile":11625.89,"90th_percentile":11625.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":24456.08,"maximum":68400.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49856.26},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39365.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49856.26},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60711.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49704.14},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68400.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55179.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":24456.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15210.9,"maximum":42543.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31009.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24483.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31009.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37760.89},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30914.4},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42543.02},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34319.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15210.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":50642.67,"10th_percentile":50642.67,"90th_percentile":50642.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":148937.42,"10th_percentile":148937.42,"90th_percentile":148937.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5694.04,"maximum":15925.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5694.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5694.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11607.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9165.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11607.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14135.39},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5694.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5694.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5694.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5694.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11572.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15925.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12847.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5694.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5694.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15836.44,"10th_percentile":15836.44,"90th_percentile":15836.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":3869.05,"maximum":10821.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3869.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3869.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":7887.46},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":6227.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":7887.46},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9604.86},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3869.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3869.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3869.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3869.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7863.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10821.25},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8729.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3869.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":3869.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4504.86,"10th_percentile":4504.86,"90th_percentile":4524.05,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3681.01,"10th_percentile":3681.01,"90th_percentile":3681.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4227.14,"10th_percentile":4227.14,"90th_percentile":4227.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3720.67,"10th_percentile":3720.67,"90th_percentile":3720.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8141.36,"maximum":22770.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16597.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13104.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16597.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20210.82},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16546.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22770.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18369.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8141.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8141.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8786.54,"10th_percentile":8786.54,"90th_percentile":8786.54,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36767.64,"10th_percentile":36767.64,"90th_percentile":36767.64,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9736.12,"10th_percentile":9736.12,"90th_percentile":9736.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":5306.24,"10th_percentile":5306.24,"90th_percentile":5306.24,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":23493.79,"maximum":65709.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47894.55},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37816.18},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47894.55},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58323.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47748.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65709.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53008.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":23493.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9713.87,"maximum":27168.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19802.73},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15635.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19802.73},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24114.56},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19742.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27168.49},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21916.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9713.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":45486.19,"10th_percentile":45486.19,"90th_percentile":45486.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8940.9,"10th_percentile":8940.9,"90th_percentile":8940.9,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10254.07,"10th_percentile":10254.07,"90th_percentile":10254.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42244.41,"10th_percentile":42244.41,"90th_percentile":42244.41,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9835.17,"10th_percentile":9835.17,"90th_percentile":10350.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":51340.26,"maximum":143592.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51340.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51340.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":104662.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":82638.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":104662.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":127451.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51340.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51340.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51340.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51340.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104343.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143592.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115836.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51340.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":51340.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8044.63,"maximum":22499.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16399.82},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12948.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16399.82},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19970.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16349.78},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22499.84},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18150.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8044.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11883.81,"maximum":33237.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24226.38},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19128.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24226.38},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29501.41},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24152.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33237.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26812.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11883.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection With Cc","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42410.87,"maximum":118617.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86458.99},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68265.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":86458.99},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105284.49},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86195.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118617.99},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95689.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42410.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":42410.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25081.95,"maximum":70151.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51132.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40372.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51132.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62265.65},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50976.16},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70151.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56591.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25081.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25081.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24728.22,"10th_percentile":24728.22,"90th_percentile":24728.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16185.28,"maximum":45268.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16185.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16185.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32995.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26052.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32995.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40179.76},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16185.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16185.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16185.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16185.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32894.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45268.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36518.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16185.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16185.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15377.34,"10th_percentile":15377.34,"90th_percentile":15377.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16665.88,"10th_percentile":16665.88,"90th_percentile":16665.88,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14449.99,"10th_percentile":14449.99,"90th_percentile":14449.99,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19714.36,"maximum":55138.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40189.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31732.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40189.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48940.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40067.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55138.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44480.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19714.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19676.31,"10th_percentile":19676.31,"90th_percentile":19676.31,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":49736.81,"10th_percentile":49736.81,"90th_percentile":49736.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14270.67,"maximum":39913.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29092.24},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22970.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29092.24},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35426.76},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29003.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39913.3},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32198.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14270.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27253.0,"10th_percentile":27253.0,"90th_percentile":27253.0,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14583.95,"10th_percentile":14583.95,"90th_percentile":14583.95,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9572.34,"maximum":26772.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19514.2},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15407.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19514.2},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23763.21},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19454.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26772.64},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21597.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9572.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":22420.87,"10th_percentile":22420.87,"90th_percentile":22420.87,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14789.15,"maximum":41363.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30149.22},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23804.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30149.22},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36713.89},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30057.23},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41363.42},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33368.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14789.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14225.86,"maximum":39787.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29000.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22898.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29000.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35315.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28912.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39787.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32097.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14225.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6787.19,"maximum":18982.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13836.4},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10924.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13836.4},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16849.12},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13794.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18982.94},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15313.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6787.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6787.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17650.39,"maximum":49365.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35982.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28410.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35982.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43816.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35872.38},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49365.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39823.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17650.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9219.57,"maximum":25786.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18795.05},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14840.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18795.05},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22887.47},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18737.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25786.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20801.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9219.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10222.93,"10th_percentile":10222.93,"90th_percentile":10222.93,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5717.51,"maximum":15991.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5717.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5717.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11655.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9203.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11655.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14193.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5717.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5717.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5717.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5717.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11620.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15991.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12900.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5717.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5717.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8152.74,"maximum":22802.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8152.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8152.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16620.2},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13122.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16620.2},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20239.07},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8152.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8152.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8152.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8152.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16569.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22802.2},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18394.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8152.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8152.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19006.21,"10th_percentile":19006.21,"90th_percentile":19006.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12289.91,"maximum":34373.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12289.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12289.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25054.27},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19782.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25054.27},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30509.57},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12289.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12289.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12289.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12289.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24977.83},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34373.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27729.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12289.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12289.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13283.92,"10th_percentile":13283.92,"90th_percentile":13283.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6164.87,"maximum":17242.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12567.73},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9923.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12567.73},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15304.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12529.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17242.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13909.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6164.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10108.6,"maximum":28272.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20607.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16271.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20607.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25094.47},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20544.55},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28272.5},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22807.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10108.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7479.9,"10th_percentile":7479.9,"90th_percentile":7479.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11137.7,"10th_percentile":11137.7,"90th_percentile":11137.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Or Insertion Of","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24803.15,"maximum":69371.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24803.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24803.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50563.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39923.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50563.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61573.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24803.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24803.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24803.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24803.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50409.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69371.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55962.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24803.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":24803.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8903.79,"maximum":24902.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18151.3},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14331.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18151.3},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22103.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18095.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24902.79},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20089.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8903.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8903.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6373.97,"maximum":17827.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12994.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10259.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12994.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15823.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12954.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17827.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14381.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6373.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6373.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4430.04,"10th_percentile":4430.04,"90th_percentile":4430.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7296.53,"10th_percentile":7296.53,"90th_percentile":7296.53,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":13517.38,"10th_percentile":13517.38,"90th_percentile":13517.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4458.28,"10th_percentile":4458.28,"90th_percentile":4458.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3353.01,"10th_percentile":3353.01,"90th_percentile":3353.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3262.35,"10th_percentile":3104.68,"90th_percentile":3849.99,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4585.58,"10th_percentile":4585.58,"90th_percentile":4585.58,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11503.91,"10th_percentile":11503.91,"90th_percentile":11503.91,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7186.33,"10th_percentile":7186.33,"90th_percentile":7186.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":14196.71,"10th_percentile":14196.71,"90th_percentile":14196.71,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":33437.38,"maximum":93520.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68165.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53821.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":68165.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83007.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67957.61},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93520.25},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75443.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":33437.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11036.74,"maximum":30868.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22499.55},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17765.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22499.55},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27398.58},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22430.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30868.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24901.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11036.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11036.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64771.55,"10th_percentile":64771.55,"90th_percentile":64771.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12441.4,"maximum":34797.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25363.1},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20025.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25363.1},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30885.64},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25285.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34797.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28071.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12441.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12441.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11883.52,"10th_percentile":11883.52,"90th_percentile":11883.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16632.63,"maximum":46519.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33907.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26772.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33907.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41290.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33803.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46519.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37527.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16632.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16632.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":33469.49,"10th_percentile":33469.49,"90th_percentile":35762.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8252.31,"maximum":23080.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16823.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13283.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16823.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20486.26},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16771.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23080.69},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18619.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8252.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7297.94,"10th_percentile":7297.94,"90th_percentile":9209.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84.83,"10th_percentile":84.83,"90th_percentile":84.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4747.28,"10th_percentile":4747.28,"90th_percentile":4747.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7311.43,"10th_percentile":6468.07,"90th_percentile":9201.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7218.9,"maximum":20190.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14716.49},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11619.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14716.49},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17920.84},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14671.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20190.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16287.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7218.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8076.44,"10th_percentile":8076.44,"90th_percentile":8076.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7636.14,"10th_percentile":7636.14,"90th_percentile":7636.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8272.42,"10th_percentile":8272.42,"90th_percentile":8272.42,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":33369.11,"maximum":93329.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33369.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33369.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68026.41},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53711.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":68026.41},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82838.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33369.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33369.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33369.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33369.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67818.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93329.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75289.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33369.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":33369.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36174.63,"10th_percentile":36174.63,"90th_percentile":36174.63,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10900.19,"maximum":30486.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10900.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10900.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22221.17},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17545.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22221.17},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27059.59},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10900.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10900.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10900.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10900.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22153.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30486.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24593.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10900.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10900.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"1 through 10","median_amount":606.0,"10th_percentile":606.0,"90th_percentile":606.0},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4464.34,"maximum":12486.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9101.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7185.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9101.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11082.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9073.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12486.21},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10072.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4464.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25806.69,"maximum":72178.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25806.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25806.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52609.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41539.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52609.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64064.8},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25806.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25806.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25806.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25806.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52449.1},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72178.12},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58226.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25806.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25806.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12442.12,"maximum":34799.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25364.55},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20027.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25364.55},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30887.41},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25287.16},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34799.06},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28072.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12442.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6297.87,"maximum":17614.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12838.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10137.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12838.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15634.39},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12799.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17614.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14209.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6297.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7248.4,"10th_percentile":7248.4,"90th_percentile":7248.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":262.1,"10th_percentile":262.1,"90th_percentile":262.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":27871.2,"10th_percentile":27871.2,"90th_percentile":27871.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8318.45,"maximum":23265.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16958.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13389.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16958.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20650.46},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16906.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23265.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18768.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8318.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8318.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14759.99,"maximum":41281.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30089.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23758.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30089.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36641.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29997.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41281.87},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33302.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14759.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7277.93,"maximum":20355.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7277.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7277.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14836.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11714.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14836.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18067.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7277.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7277.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7277.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7277.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14791.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20355.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16420.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7277.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7277.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":15732.98,"10th_percentile":15732.98,"90th_percentile":15732.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":728.74,"10th_percentile":728.74,"90th_percentile":728.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8124.7,"10th_percentile":7044.17,"90th_percentile":8254.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":17237.71,"10th_percentile":17237.71,"90th_percentile":53190.93,"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":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6975.39,"10th_percentile":6425.34,"90th_percentile":7529.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8200.59,"10th_percentile":8200.59,"90th_percentile":8200.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5514.26,"10th_percentile":5514.26,"90th_percentile":5514.26,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14902.86,"10th_percentile":14902.86,"90th_percentile":31062.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":20508.65,"10th_percentile":16087.31,"90th_percentile":22442.97,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":14588.03,"10th_percentile":12879.32,"90th_percentile":14890.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8171.12,"10th_percentile":4788.74,"90th_percentile":8308.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6313.52,"maximum":17658.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12870.76},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10162.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12870.76},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15673.23},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12831.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17658.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14244.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6313.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4620.58,"10th_percentile":4620.58,"90th_percentile":4620.58,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":35124.4,"maximum":98238.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35124.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35124.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71604.76},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56537.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":71604.76},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87195.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35124.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35124.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35124.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35124.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71386.28},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98238.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79249.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35124.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":35124.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37730.39,"10th_percentile":37730.39,"90th_percentile":37730.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11317.99,"10th_percentile":11317.99,"90th_percentile":11317.99,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38805.61,"10th_percentile":38805.61,"90th_percentile":38805.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58212.41,"10th_percentile":58212.41,"90th_percentile":58212.41,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10906.16,"10th_percentile":10906.16,"90th_percentile":10906.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14187.45,"maximum":39680.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28922.61},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22836.47},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28922.61},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35220.19},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28834.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39680.56},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32010.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14187.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":27450.96,"10th_percentile":27450.96,"90th_percentile":27450.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14834.67,"maximum":41490.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30242.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23878.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30242.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36826.88},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30149.74},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41490.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33470.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14834.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16437.76,"maximum":45974.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33510.09},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26458.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33510.09},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40806.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33407.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45974.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37087.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16437.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6115.8,"maximum":17105.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12467.69},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9844.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12467.69},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15182.39},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12429.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17105.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13798.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6115.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6115.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9987.69,"maximum":27934.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20360.95},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16076.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20360.95},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24794.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20298.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27934.34},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22534.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9987.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9987.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11007.26,"10th_percentile":11007.26,"90th_percentile":11007.26,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10907.08,"10th_percentile":10907.08,"90th_percentile":10907.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13220.9,"maximum":36977.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26952.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21280.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26952.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32820.74},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26869.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36977.24},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29829.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13220.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":1421.02,"maximum":3974.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":2896.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":2287.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":2896.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3527.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2888.06},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3974.42},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3206.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1421.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":1421.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":1977.47,"10th_percentile":1714.02,"90th_percentile":3187.58,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1529.14,"10th_percentile":1529.14,"90th_percentile":1554.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"48","median_amount":1335.0,"10th_percentile":1068.03,"90th_percentile":2670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"12","median_amount":1335.0,"10th_percentile":1068.0,"90th_percentile":2670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1554.28,"10th_percentile":1554.28,"90th_percentile":1554.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":3405.27,"10th_percentile":3405.27,"90th_percentile":3405.27},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1554.28,"10th_percentile":1554.28,"90th_percentile":1554.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1554.28,"10th_percentile":1554.28,"90th_percentile":1554.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1529.14,"10th_percentile":1529.14,"90th_percentile":1554.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"17","median_amount":624.13,"10th_percentile":605.26,"90th_percentile":636.0,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2888.06,"10th_percentile":2598.1,"90th_percentile":7152.71,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1529.14,"10th_percentile":1529.14,"90th_percentile":1529.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":3519.0,"10th_percentile":2856.67,"90th_percentile":4692.0,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":1629.0,"10th_percentile":1589.0,"90th_percentile":3585.15,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1529.14,"10th_percentile":1529.14,"90th_percentile":1554.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2137.88,"10th_percentile":2137.88,"90th_percentile":2137.88,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7942.93,"maximum":22215.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16192.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12785.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16192.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19718.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16143.08},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22215.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17921.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7942.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":17364.0,"10th_percentile":16691.0,"90th_percentile":18702.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7488.74,"10th_percentile":7488.74,"90th_percentile":7488.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4940.0,"10th_percentile":4940.0,"90th_percentile":4940.0,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19336.0,"10th_percentile":19336.0,"90th_percentile":19336.0,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":15331.61,"10th_percentile":15331.61,"90th_percentile":15331.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4430.9,"10th_percentile":4430.9,"90th_percentile":4430.9,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12018.23,"maximum":33613.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24500.41},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19344.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24500.41},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29835.11},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24425.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33613.5},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27116.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12018.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7736.67,"maximum":21638.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15772.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12453.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15772.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19206.2},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15723.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21638.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17455.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7736.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14573.65,"maximum":40760.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29709.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23458.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29709.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36178.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29619.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40760.7},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32881.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14573.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14573.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25422.63,"maximum":71103.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25422.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25422.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51826.68},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40920.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51826.68},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63111.37},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25422.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25422.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25422.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25422.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51668.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71103.95},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57360.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25422.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25422.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8322.72,"maximum":23277.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16966.73},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13396.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16966.73},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20661.05},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16914.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23277.62},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18778.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8322.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7520.46,"maximum":21033.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15331.24},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12105.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15331.24},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18669.45},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15284.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21033.8},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16968.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7520.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4906.72,"maximum":13723.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10002.86},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7897.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10002.86},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12180.87},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9972.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13723.49},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11070.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4906.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10034.49,"10th_percentile":10034.49,"90th_percentile":10034.49,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5892.34,"10th_percentile":5892.34,"90th_percentile":5892.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14329.7,"maximum":40078.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29212.59},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23065.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29212.59},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35573.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29123.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40078.4},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32331.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14329.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12847.51,"maximum":35932.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26190.99},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20679.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26190.99},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31893.8},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26111.08},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35932.91},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28987.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12847.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12847.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14779.9,"maximum":41337.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30130.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23790.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30130.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36690.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30038.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41337.57},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33347.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14779.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14779.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14268.46,"10th_percentile":14268.46,"90th_percentile":14268.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5733.16,"maximum":16034.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11687.64},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9228.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11687.64},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14232.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11651.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16034.94},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12935.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5733.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12563.73,"maximum":35139.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25612.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20222.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25612.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31189.32},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25534.33},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35139.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28347.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12563.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10088.67,"10th_percentile":10088.67,"90th_percentile":10088.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6216.79,"maximum":17387.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12673.58},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10006.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12673.58},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15433.11},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12634.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17387.6},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14026.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6216.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6216.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6352.63,"maximum":17767.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12950.51},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10225.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12950.51},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15770.34},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12910.99},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17767.53},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14333.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6352.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8755.28,"10th_percentile":8755.28,"90th_percentile":8755.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":964.03,"10th_percentile":964.03,"90th_percentile":964.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5329.19,"maximum":14905.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10864.1},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8577.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10864.1},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13229.64},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10830.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14905.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12024.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5329.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5329.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18852.36,"maximum":52727.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38432.5},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30345.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38432.5},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46800.76},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38315.23},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52727.72},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42535.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18852.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18852.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13720.18,"maximum":38373.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13720.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13720.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27970.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22084.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27970.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34060.19},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13720.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13720.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13720.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13720.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27884.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38373.66},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30956.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13720.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13720.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5472.14,"maximum":15304.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5472.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5472.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11155.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8808.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11155.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13584.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5472.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5472.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5472.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5472.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11121.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15304.9},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12346.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5472.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5472.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6446.52,"maximum":18030.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13141.89},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10376.47},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13141.89},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16003.4},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13101.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18030.11},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14545.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6446.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7037.06,"10th_percentile":7037.06,"90th_percentile":7037.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10728.07,"maximum":30005.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10728.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10728.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21870.29},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17268.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21870.29},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26632.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10728.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10728.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10728.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10728.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21803.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30005.09},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24205.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10728.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10728.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15496.1,"maximum":43340.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31590.42},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24942.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31590.42},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38468.89},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31494.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43340.69},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34963.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15496.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15496.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14405.96,"10th_percentile":14405.96,"90th_percentile":14405.96,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11707.42,"maximum":32744.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23866.8},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18844.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23866.8},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29063.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23793.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32744.22},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26414.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11707.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11184.03,"10th_percentile":11184.03,"90th_percentile":12799.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15053.72,"maximum":42103.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30688.58},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24230.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30688.58},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37370.69},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30594.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42103.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33965.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15053.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15053.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10811.99,"maximum":30239.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22041.38},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17403.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22041.38},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26840.65},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21974.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30239.82},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24394.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10811.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10811.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12240.17,"10th_percentile":12240.17,"90th_percentile":12240.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12766.43,"maximum":35706.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26025.71},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20549.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26025.71},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31692.52},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25946.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35706.14},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28804.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12766.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12766.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12828.31,"maximum":35879.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12828.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12828.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26151.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20648.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26151.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31846.13},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12828.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12828.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12828.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12828.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26072.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35879.2},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28943.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12828.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12828.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4900.32,"maximum":13705.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4900.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4900.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9989.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7887.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9989.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12164.98},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4900.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4900.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4900.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4900.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9959.33},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13705.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11056.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4900.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4900.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":24383.53,"maximum":68197.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24383.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24383.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49708.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39248.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49708.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60531.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24383.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24383.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24383.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24383.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49556.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68197.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55015.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24383.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":24383.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26534.18,"10th_percentile":26534.18,"90th_percentile":26534.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18757.77,"maximum":52463.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18757.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18757.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38239.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30192.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38239.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46565.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18757.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18757.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18757.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18757.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38122.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52463.16},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42322.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18757.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18757.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":26763.28,"maximum":74853.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54559.74},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43078.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54559.74},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66439.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54393.26},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74853.6},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60384.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":26763.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11013.98,"maximum":30804.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22453.15},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17728.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22453.15},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27342.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22384.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30804.75},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24850.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11013.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11013.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":51013.81,"maximum":142679.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51013.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51013.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":103996.98},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":82113.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":103996.98},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126641.19},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51013.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51013.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51013.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51013.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103679.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142679.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115100.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51013.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":51013.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11154.8,"maximum":31198.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22740.23},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17955.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22740.23},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27691.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22670.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31198.61},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25168.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11154.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6939.16,"10th_percentile":6939.16,"90th_percentile":6939.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10992.84,"10th_percentile":10992.84,"90th_percentile":10992.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6939.16,"10th_percentile":6939.16,"90th_percentile":6939.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12635.32,"10th_percentile":12635.32,"90th_percentile":12635.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12103.32,"10th_percentile":12103.32,"90th_percentile":12103.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13970.53,"maximum":39073.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28480.39},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22487.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28480.39},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34681.68},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28393.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39073.86},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31521.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13970.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13970.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10068.06,"maximum":28159.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20524.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16205.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20524.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24993.83},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20462.16},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28159.12},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22716.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10068.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6691.89,"maximum":18716.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13642.11},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10771.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13642.11},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16612.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13600.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18716.38},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15098.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6691.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14887.3,"maximum":41637.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30349.31},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23962.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30349.31},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36957.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30256.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41637.93},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33589.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14887.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14887.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":32351.35,"maximum":90482.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65951.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52073.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65951.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80311.85},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65750.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90482.74},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72992.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":32351.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31610.76,"10th_percentile":31610.76,"90th_percentile":31610.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18438.43,"maximum":51570.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18438.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18438.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37588.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29678.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37588.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45773.18},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18438.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18438.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18438.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18438.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37473.97},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51570.01},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41601.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18438.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18438.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14846.05,"maximum":41522.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30265.21},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23896.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30265.21},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36855.13},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30172.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41522.56},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33496.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14846.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10703.89,"maximum":29937.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21821.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17229.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21821.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26572.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21754.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29937.46},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24150.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10703.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8563.11,"maximum":23949.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17456.8},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13783.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17456.8},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21257.82},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17403.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23949.97},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19320.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8563.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15125.56,"maximum":42304.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30835.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24346.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30835.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37549.02},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30740.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42304.32},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34127.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15125.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":30310.16,"10th_percentile":30310.16,"90th_percentile":30310.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5362.61,"maximum":14998.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10932.25},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8631.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10932.25},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13312.62},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10898.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14998.57},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12099.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5362.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"1 through 10","median_amount":21307.26,"10th_percentile":21307.26,"90th_percentile":21307.26,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2985.88,"10th_percentile":2985.88,"90th_percentile":2985.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":9346.0,"10th_percentile":9346.0,"90th_percentile":10333.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":8433.0,"10th_percentile":8433.0,"90th_percentile":8433.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2985.88,"10th_percentile":2985.88,"90th_percentile":2985.88,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2985.88,"10th_percentile":2985.88,"90th_percentile":2985.88,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2757.19,"10th_percentile":2757.19,"90th_percentile":2983.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3208.85,"10th_percentile":2757.19,"90th_percentile":3364.96,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":2143.23,"10th_percentile":2143.23,"90th_percentile":2143.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6807.1,"maximum":19038.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13876.99},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10956.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13876.99},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16898.56},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13834.65},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19038.63},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15358.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6807.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":9346.0,"10th_percentile":9346.0,"90th_percentile":9346.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":42271.47,"maximum":118228.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42271.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42271.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86174.81},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68041.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":86174.81},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104938.44},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42271.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42271.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42271.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42271.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85911.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118228.1},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95375.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42271.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":42271.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5983.51,"maximum":16735.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12198.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9631.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12198.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14853.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12160.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16735.14},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13500.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5983.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5983.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6962.86,"maximum":19474.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6962.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6962.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14194.52},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11207.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14194.52},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17285.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6962.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6962.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6962.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6962.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14151.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19474.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15710.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6962.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6962.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6114.37,"maximum":17101.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12464.79},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9841.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12464.79},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15178.86},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12426.76},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17101.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13795.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6114.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25481.66,"maximum":71269.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25481.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25481.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51947.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41015.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51947.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63257.92},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25481.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25481.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25481.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25481.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51788.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71269.06},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57493.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25481.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25481.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5769.43,"maximum":16136.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5769.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5769.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11761.59},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9286.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11761.59},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14322.55},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5769.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5769.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5769.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5769.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11725.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16136.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13017.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5769.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5769.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6510.52,"10th_percentile":6510.52,"90th_percentile":6510.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4068.12,"10th_percentile":4068.12,"90th_percentile":4068.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13445.65,"maximum":37605.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27410.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21642.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27410.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33378.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27326.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37605.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30336.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16550.84,"maximum":46290.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33740.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26640.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33740.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41087.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33637.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46290.67},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37342.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16550.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":80594.24,"maximum":225412.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80594.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80594.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":164299.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":129726.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":164299.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":200074.26},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80594.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80594.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80594.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80594.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163798.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225412.17},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181841.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80594.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":80594.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":38790.75,"maximum":108492.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79079.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62438.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79079.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96297.59},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78837.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108492.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87521.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38790.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":38790.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":55964.63,"maximum":156526.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55964.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55964.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":114089.73},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":90082.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":114089.73},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":138931.53},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55964.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55964.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55964.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55964.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113741.62},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156526.17},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126270.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55964.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":55964.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":42732.34,"maximum":119517.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42732.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42732.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":87114.34},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68783.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":87114.34},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106082.54},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42732.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42732.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42732.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42732.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86848.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119517.1},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96415.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42732.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":42732.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13817.62,"maximum":38646.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28168.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22241.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28168.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34302.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28082.71},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38646.18},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31176.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13817.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6964.28,"maximum":19478.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14197.42},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11209.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14197.42},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17288.76},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14154.1},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19478.25},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15713.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6964.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":19609.1,"maximum":54844.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19609.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19609.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39975.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31563.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39975.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48679.36},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19609.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19609.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19609.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19609.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39853.22},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54844.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44243.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19609.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":19609.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5681.24,"maximum":15889.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11581.8},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9144.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11581.8},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14103.61},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11546.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15889.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12818.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5681.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1547.85,"10th_percentile":1547.85,"90th_percentile":1547.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6647.24,"10th_percentile":6647.24,"90th_percentile":6647.24,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12873.12,"maximum":36004.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12873.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12873.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26243.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20720.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26243.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31957.36},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12873.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12873.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12873.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12873.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26163.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36004.52},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29045.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12873.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12873.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9614.3,"maximum":26890.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19599.75},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15475.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19599.75},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23867.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19539.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26890.01},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21692.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9614.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18343.83,"maximum":51305.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37395.82},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29526.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37395.82},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45538.36},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37281.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51305.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41388.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18343.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16721.54,"maximum":46768.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34088.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26915.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34088.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41511.02},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33984.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46768.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37728.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16721.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16721.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9410.18,"maximum":26319.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19183.63},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15146.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19183.63},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23360.65},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19125.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26319.11},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21231.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9410.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9410.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15512.46,"maximum":43386.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31623.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24969.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31623.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38509.5},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31527.28},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43386.44},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35000.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15512.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15512.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5345.54,"maximum":14950.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10897.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8604.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10897.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13270.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10864.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14950.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12060.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5345.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":873.73,"10th_percentile":873.73,"90th_percentile":873.73,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":16499.21,"10th_percentile":16499.21,"90th_percentile":16499.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5974.52,"10th_percentile":5974.52,"90th_percentile":5974.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12210.26,"maximum":34150.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24891.88},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19653.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24891.88},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30311.82},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24815.93},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34150.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27549.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12210.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9718.14,"maximum":27180.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19811.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15642.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19811.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24125.16},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19750.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27180.43},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21926.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9718.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9718.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7617.19,"maximum":21304.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7617.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7617.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15528.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12260.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15528.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18909.58},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7617.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7617.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7617.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7617.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15481.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21304.33},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17186.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7617.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7617.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7770.78,"10th_percentile":7770.78,"90th_percentile":7770.78,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":8786.43,"maximum":24574.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17912.06},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14142.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17912.06},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21812.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17857.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24574.58},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19824.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":8786.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6617.14,"10th_percentile":3931.4,"90th_percentile":8306.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8550.18,"10th_percentile":8550.18,"90th_percentile":8550.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7648.53,"10th_percentile":7648.53,"90th_percentile":7648.53,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6740.94,"10th_percentile":6740.94,"90th_percentile":6740.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5818.5,"10th_percentile":5818.5,"90th_percentile":5818.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6298.46,"10th_percentile":6072.63,"90th_percentile":7351.87,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8103.73,"10th_percentile":8103.73,"90th_percentile":8103.73,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10550.81,"10th_percentile":10550.81,"90th_percentile":10550.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":13603.6,"10th_percentile":13603.6,"90th_percentile":13603.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7673.08,"10th_percentile":6881.78,"90th_percentile":9706.58,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10714.35,"10th_percentile":10714.35,"90th_percentile":10714.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6750.21,"maximum":18879.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13761.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10865.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13761.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16757.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13719.01},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18879.5},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15230.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6750.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13022.47,"maximum":36422.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26547.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20961.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26547.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32328.14},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26466.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36422.25},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29382.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13022.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13022.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13501.82,"10th_percentile":13501.82,"90th_percentile":13501.82,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":69577.41,"maximum":194599.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":141840.82},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":111993.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":141840.82},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":172725.12},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141408.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194599.46},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156984.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69577.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":69577.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8476.56,"10th_percentile":8476.56,"90th_percentile":8476.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":59955.29,"maximum":167687.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59955.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59955.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":122225.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":96505.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":122225.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":148838.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59955.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59955.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59955.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59955.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121852.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167687.57},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135274.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59955.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":59955.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9846.16,"maximum":27538.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20072.42},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15848.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20072.42},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24442.97},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20011.17},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27538.48},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22215.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9846.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9846.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":18460.47,"maximum":51631.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37633.6},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29714.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37633.6},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45827.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37518.78},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51631.68},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41651.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":18460.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":43627.36,"10th_percentile":43627.36,"90th_percentile":43627.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16599.63,"10th_percentile":16599.63,"90th_percentile":16599.63,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13445.65,"maximum":37605.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27410.36},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21642.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27410.36},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33378.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27326.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37605.83},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30336.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13445.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":30036.32,"maximum":84007.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61232.18},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48347.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61232.18},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74564.82},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61045.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84007.89},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67769.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30036.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":30036.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29348.74,"10th_percentile":29348.74,"90th_percentile":29348.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":32847.78,"maximum":91871.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32847.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32847.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":66963.63},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52872.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":66963.63},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81544.24},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32847.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32847.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32847.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32847.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66759.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91871.2},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74113.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32847.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":32847.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4259.51,"maximum":11913.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4259.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4259.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8683.45},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":6856.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":8683.45},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10574.18},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4259.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4259.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4259.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4259.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8656.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11913.32},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9610.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4259.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4259.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4025.52,"maximum":11258.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4025.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4025.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8206.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":6479.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":8206.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9993.3},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4025.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4025.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4025.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4025.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8181.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11258.87},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9082.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4025.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4025.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4787.95,"maximum":13391.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9760.73},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7706.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9760.73},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11886.02},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9730.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13391.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10802.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4787.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":252.7,"10th_percentile":252.7,"90th_percentile":252.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48.93,"10th_percentile":48.93,"90th_percentile":48.93,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3854.52,"10th_percentile":3854.52,"90th_percentile":3854.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4569.03,"10th_percentile":4569.03,"90th_percentile":4569.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4992.07,"maximum":13962.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10176.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8035.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10176.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12392.75},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10145.8},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13962.19},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11263.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4992.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4992.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":31741.12,"maximum":88776.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31741.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31741.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64707.59},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51091.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64707.59},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78796.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31741.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31741.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31741.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31741.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64510.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88776.01},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71616.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31741.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":31741.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17383.68,"maximum":48620.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35438.46},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27981.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35438.46},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43154.8},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35330.32},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48620.03},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39222.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17383.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17383.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19353.37,"10th_percentile":19353.37,"90th_percentile":19353.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25397.02,"maximum":71032.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25397.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25397.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51774.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40879.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51774.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63047.81},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25397.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25397.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25397.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25397.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51616.5},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71032.34},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57302.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25397.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25397.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6191.9,"maximum":17317.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12622.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9966.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12622.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15371.31},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12584.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17317.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13970.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6191.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16539.46,"maximum":46258.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16539.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16539.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33717.42},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26622.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33717.42},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41059.03},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16539.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16539.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16539.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16539.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33614.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46258.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37317.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16539.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16539.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10057.64,"10th_percentile":10057.64,"90th_percentile":10057.64,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7261.58,"maximum":20309.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14803.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11688.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14803.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18026.78},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14758.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20309.73},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16383.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7261.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7772.75,"10th_percentile":7772.75,"90th_percentile":7772.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":20245.32,"10th_percentile":20245.32,"90th_percentile":20245.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7225.32,"10th_percentile":7225.32,"90th_percentile":7225.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5588.44,"10th_percentile":5588.44,"90th_percentile":5588.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8610.0,"10th_percentile":8610.0,"90th_percentile":8610.0,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13955.6,"maximum":39032.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28449.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22463.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28449.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34644.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28363.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39032.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31487.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13955.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10503.32,"maximum":29376.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21412.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16906.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21412.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26074.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21346.79},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29376.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23698.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10503.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10503.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12206.12,"10th_percentile":12206.12,"90th_percentile":12206.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":27581.56,"10th_percentile":27581.56,"90th_percentile":27581.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10262.89,"10th_percentile":10262.89,"90th_percentile":10262.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15314.97,"10th_percentile":15314.97,"90th_percentile":15314.97,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12308.5,"10th_percentile":12308.5,"90th_percentile":12308.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17033.05,"maximum":47639.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34723.66},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27416.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34723.66},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42284.35},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34617.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47639.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38430.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17033.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15485.43,"maximum":43310.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31568.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24925.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31568.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38442.41},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31472.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43310.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34939.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15485.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15485.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":16972.6,"maximum":47470.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34600.41},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27319.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34600.41},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42134.28},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34494.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47470.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38294.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":16972.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18277.76,"10th_percentile":18277.76,"90th_percentile":18277.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10777.29,"10th_percentile":10777.29,"90th_percentile":10777.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10670.46,"maximum":29843.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10670.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10670.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21752.85},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17175.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21752.85},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26489.3},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10670.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10670.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10670.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10670.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21686.48},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29843.97},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24075.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10670.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10670.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":5067.46,"maximum":14173.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10330.54},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8156.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10330.54},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12579.9},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10299.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14173.05},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11433.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":5067.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12063.31,"10th_percentile":12063.31,"90th_percentile":12063.31,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6865.42,"maximum":19201.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13995.88},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11050.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13995.88},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17043.34},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13953.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19201.75},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15490.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6865.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5416.56,"10th_percentile":5416.56,"90th_percentile":5416.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7387.33,"10th_percentile":7387.33,"90th_percentile":7387.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8065.88,"10th_percentile":8065.88,"90th_percentile":8065.88,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22975.31,"maximum":64259.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46837.57},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36981.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46837.57},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57035.94},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46694.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64259.12},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51838.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22975.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22975.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12970.55,"maximum":36277.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26441.83},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20877.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26441.83},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32199.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26361.15},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36277.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29264.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12970.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":17363.06,"maximum":48562.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35396.41},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27948.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35396.41},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43103.59},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35288.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48562.34},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39175.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17363.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":17363.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14896.54,"maximum":41663.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30368.16},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23977.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30368.16},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36980.49},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30275.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41663.79},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33610.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14896.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15996.69,"10th_percentile":15996.69,"90th_percentile":15996.69,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12180.46,"10th_percentile":12180.46,"90th_percentile":12180.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15179.75,"10th_percentile":14447.08,"90th_percentile":16041.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12680.75,"10th_percentile":12680.75,"90th_percentile":12680.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15924.14,"10th_percentile":15046.32,"90th_percentile":15932.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15915.55,"10th_percentile":15915.55,"90th_percentile":15915.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Or Insertion Of Antibioti","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26113.22,"maximum":73035.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26113.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26113.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53234.53},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42032.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53234.53},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64825.77},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26113.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26113.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26113.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26113.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53072.1},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73035.47},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58918.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26113.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":26113.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22508.75,"maximum":62954.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45886.44},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36230.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45886.44},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55877.71},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45746.42},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62954.2},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50785.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22508.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10770.74,"maximum":30124.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21957.29},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17336.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21957.29},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26738.25},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21890.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30124.44},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24301.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10929.35,"maximum":30568.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22280.61},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17592.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22280.61},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27131.98},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22212.63},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30568.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24659.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10929.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":9117.86,"maximum":25501.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18587.72},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14676.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18587.72},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22634.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18531.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25501.54},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20572.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9117.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":9117.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8337.28,"10th_percentile":8337.28,"90th_percentile":8337.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10444.76,"10th_percentile":10444.76,"90th_percentile":10444.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7311.36,"maximum":20448.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14904.97},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11768.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14904.97},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18150.37},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14859.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20448.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16496.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7311.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8312.88,"10th_percentile":8312.88,"90th_percentile":8315.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":14818.93,"10th_percentile":14818.93,"90th_percentile":14818.93,"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":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7210.98,"10th_percentile":7210.98,"90th_percentile":7210.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11920.79,"maximum":33340.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24301.77},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19187.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24301.77},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29593.22},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24227.62},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33340.98},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26896.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11920.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11920.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12648.66,"10th_percentile":12648.66,"90th_percentile":12648.66,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7898.61,"10th_percentile":7898.61,"90th_percentile":7898.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13263.58,"maximum":37096.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27039.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21349.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27039.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32926.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26956.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37096.59},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29926.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13263.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":20917.75,"maximum":58504.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20917.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20917.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42643.01},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33669.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42643.01},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51928.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20917.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20917.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20917.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20917.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42512.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58504.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47195.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20917.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":20917.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":11425.07,"maximum":31954.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11425.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11425.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23291.19},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18390.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23291.19},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28362.6},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11425.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11425.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11425.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11425.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23220.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31954.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25777.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11425.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":11425.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":13764.28,"maximum":38496.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13764.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13764.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28059.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22155.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28059.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34169.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13764.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13764.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13764.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13764.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27974.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38496.99},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31055.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13764.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":13764.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7408.09,"maximum":20719.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15102.16},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11924.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15102.16},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18390.49},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15056.08},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20719.51},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16714.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7408.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7408.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15588.56,"maximum":43599.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15588.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15588.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31778.91},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25091.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31778.91},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38698.42},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15588.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15588.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15588.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15588.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31681.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43599.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35171.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15588.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15588.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":25313.81,"maximum":70799.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25313.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25313.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51604.84},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40745.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51604.84},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62841.24},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25313.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25313.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25313.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25313.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51447.38},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70799.61},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57114.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25313.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":25313.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10380.28,"maximum":29032.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21161.29},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16708.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21161.29},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25768.93},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21096.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29032.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23420.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10380.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7290.02,"maximum":20389.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14861.48},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11734.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14861.48},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18097.4},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14816.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20389.3},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16448.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7290.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7290.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8179.42,"10th_percentile":8179.42,"90th_percentile":8179.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":75.75,"10th_percentile":75.75,"90th_percentile":75.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8171.11,"10th_percentile":8171.11,"90th_percentile":8171.11,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22643.88,"maximum":63332.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46161.92},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36448.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46161.92},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56213.17},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46021.06},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63332.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51090.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22643.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22643.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25492.45,"10th_percentile":25492.45,"90th_percentile":25492.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7445.78,"maximum":20824.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15179.0},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11984.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15179.0},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18484.07},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15132.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20824.93},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16799.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7445.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7677.64,"maximum":21473.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15651.67},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12358.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15651.67},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19059.65},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15603.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21473.41},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17322.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7677.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7452.18,"maximum":20842.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15192.05},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11995.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15192.05},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18499.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15145.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20842.84},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16814.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7452.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7452.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7665.55,"maximum":21439.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7665.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7665.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15627.02},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12338.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15627.02},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19029.64},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7665.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7665.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7665.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7665.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15579.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21439.6},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17295.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7665.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7665.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12190.34,"maximum":34094.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24851.29},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19621.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24851.29},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30262.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24775.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34094.89},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27504.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12190.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12190.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":43536.02,"maximum":121764.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":88752.73},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":70076.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":88752.73},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108077.67},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88481.92},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121764.9},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98228.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":43536.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":47873.06,"maximum":133895.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47873.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47873.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":97594.22},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":77057.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":97594.22},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118844.3},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47873.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47873.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47873.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47873.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97296.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133895.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108013.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47873.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":47873.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":14421.45,"maximum":40335.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29399.62},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23213.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29399.62},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35801.07},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29309.92},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40335.01},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32538.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":14421.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":151849.43,"maximum":424704.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151849.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151849.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":309560.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":244420.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":309560.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":376964.43},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151849.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151849.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151849.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151849.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":308616.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":424704.15},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":342611.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151849.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":151849.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4738.87,"maximum":13254.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9660.68},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7627.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9660.68},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11764.19},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9631.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13254.04},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10692.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4738.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":479.07,"10th_percentile":479.07,"90th_percentile":479.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10550.27,"maximum":29507.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21507.82},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16981.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21507.82},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26190.91},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21442.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29507.79},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23804.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10550.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4387.53,"maximum":12271.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4387.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4387.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":8944.43},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7062.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":8944.43},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10891.99},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4387.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4387.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4387.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4387.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8917.14},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12271.37},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9899.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4387.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4387.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3249.78,"10th_percentile":3249.78,"90th_percentile":3249.78,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":536.28,"10th_percentile":536.28,"90th_percentile":536.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6829.15,"maximum":19100.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13921.94},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10992.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13921.94},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16953.29},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13879.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19100.3},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15408.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6829.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5072.8,"10th_percentile":5072.8,"90th_percentile":5072.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7550.69,"10th_percentile":7550.69,"90th_percentile":7550.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13856.33,"10th_percentile":13856.33,"90th_percentile":13856.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5761.94,"10th_percentile":5761.94,"90th_percentile":7550.05,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6184.79,"maximum":17298.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6184.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6184.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12608.33},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9955.18},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12608.33},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15353.66},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6184.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6184.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6184.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6184.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12569.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17298.08},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13954.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6184.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6184.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":267.45,"10th_percentile":267.45,"90th_percentile":267.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7601.38,"10th_percentile":7601.38,"90th_percentile":7601.38,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10648.41,"maximum":29782.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21707.9},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17139.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21707.9},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26434.56},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21641.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29782.3},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24025.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10648.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":6056.77,"maximum":16940.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12347.35},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9749.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12347.35},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15035.85},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12309.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16940.03},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13665.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":6056.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":34169.23,"maximum":95567.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34169.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34169.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69657.55},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54999.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69657.55},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84824.72},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34169.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34169.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34169.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34169.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69445.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95567.14},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77094.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34169.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":34169.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":22474.61,"maximum":62858.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22474.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22474.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45816.84},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36175.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45816.84},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55792.96},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22474.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22474.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22474.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22474.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45677.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62858.72},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50708.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22474.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":22474.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":15921.41,"maximum":44530.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32457.46},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25627.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32457.46},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39524.72},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32358.43},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44530.23},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35922.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":15921.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10848.27,"maximum":30341.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22115.32},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17461.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22115.32},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26930.7},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22047.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30341.27},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24476.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10848.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":169.95,"10th_percentile":169.95,"90th_percentile":169.95,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10075.52,"10th_percentile":10075.52,"90th_percentile":10075.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":71091.78,"10th_percentile":71091.78,"90th_percentile":71091.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":112.2,"10th_percentile":112.2,"90th_percentile":10992.58,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6801.47,"10th_percentile":6801.47,"90th_percentile":6801.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10356.57,"10th_percentile":10356.57,"90th_percentile":11980.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7675.51,"maximum":21467.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15647.32},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12354.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15647.32},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19054.36},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15599.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21467.45},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17317.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7675.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7675.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4255.22,"10th_percentile":4255.22,"90th_percentile":4255.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":7476.8,"10th_percentile":7476.8,"90th_percentile":7476.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2986.49,"10th_percentile":2986.49,"90th_percentile":2986.49,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3059.71,"10th_percentile":3059.71,"90th_percentile":3059.71,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30891.88,"10th_percentile":30891.88,"90th_percentile":30891.88,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":7115.06,"maximum":19899.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14504.8},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11452.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14504.8},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17663.06},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14460.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19899.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16053.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7115.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":7115.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12817.64,"maximum":35849.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26130.1},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20631.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26130.1},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31819.64},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26050.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35849.36},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28919.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12817.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":2532.9,"10th_percentile":2532.9,"90th_percentile":2805.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"1 through 10","median_amount":2804.0,"10th_percentile":2804.0,"90th_percentile":2804.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":4790.29,"10th_percentile":4790.29,"90th_percentile":4790.29},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":824.57,"10th_percentile":824.57,"90th_percentile":1601.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4413.0,"10th_percentile":4413.0,"90th_percentile":4413.0,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"1 through 10","median_amount":635.2,"10th_percentile":635.2,"90th_percentile":635.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":4656.37,"maximum":13023.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4656.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4656.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9492.5},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":7495.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9492.5},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11559.38},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4656.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4656.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4656.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4656.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9463.53},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13023.29},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10505.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4656.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":4656.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"1 through 10","median_amount":10345.04,"10th_percentile":10345.04,"90th_percentile":24712.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1643.63,"10th_percentile":1643.63,"90th_percentile":1643.63,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9601.0,"10th_percentile":9601.0,"90th_percentile":9601.0,"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":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6160.2,"10th_percentile":6160.2,"90th_percentile":6160.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10183.99,"maximum":28483.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20761.12},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16392.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20761.12},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25281.63},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20697.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28483.35},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22977.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10183.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":12354.64,"maximum":34554.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25186.21},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19886.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25186.21},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30670.24},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25109.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34554.39},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27875.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12354.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":12354.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10444.29,"maximum":29211.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21291.78},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16811.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21291.78},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25927.84},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21226.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29211.4},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23565.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10444.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10546.71,"maximum":29497.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21500.57},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16976.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21500.57},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26182.08},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21434.96},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29497.85},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23796.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10546.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Male Reproductive System And Other O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10462.07,"maximum":29261.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21328.03},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16840.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21328.03},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25971.98},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21262.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29261.13},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23605.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10462.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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","minimum":10911.57,"maximum":30518.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22244.37},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17563.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22244.37},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27087.84},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22176.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30518.31},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24619.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10911.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"fee schedule","standard_charge_dollar":10911.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":3326.79,"10th_percentile":3326.79,"90th_percentile":3433.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2867.77,"10th_percentile":2867.77,"90th_percentile":2867.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":13287.0,"10th_percentile":13081.21,"90th_percentile":13527.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":8858.0,"10th_percentile":8858.0,"90th_percentile":8858.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3349.61,"10th_percentile":3349.61,"90th_percentile":3349.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":15098.37,"10th_percentile":15098.37,"90th_percentile":15098.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":18804.11,"10th_percentile":18804.11,"90th_percentile":18804.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3526.33,"10th_percentile":3526.33,"90th_percentile":3526.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":2256.51,"10th_percentile":2256.51,"90th_percentile":5234.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":771.2,"10th_percentile":771.2,"90th_percentile":771.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2443.41,"10th_percentile":2443.41,"90th_percentile":2443.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":11204.57,"10th_percentile":10245.0,"90th_percentile":14073.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":8410.52,"10th_percentile":4743.0,"90th_percentile":19764.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":21788.11,"10th_percentile":21788.11,"90th_percentile":36361.36},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2986.16,"10th_percentile":2986.16,"90th_percentile":2986.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3511.01,"10th_percentile":3511.01,"90th_percentile":3511.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":599.26,"10th_percentile":599.26,"90th_percentile":4521.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":25177.66,"10th_percentile":25177.66,"90th_percentile":25177.66},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":977.55,"10th_percentile":977.55,"90th_percentile":977.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":22548.66,"10th_percentile":22548.66,"90th_percentile":27828.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":12606.18,"10th_percentile":12606.18,"90th_percentile":12606.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1906.68,"10th_percentile":1906.68,"90th_percentile":1906.68,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2492.76,"10th_percentile":2400.95,"90th_percentile":2986.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, glycopyrrolate, 0.1 mg","code_information":[{"code":"0792","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":700.44,"10th_percentile":700.44,"90th_percentile":700.44},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endo, single, urinary tract","code_information":[{"code":"2040","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8753.37,"10th_percentile":8753.37,"90th_percentile":8753.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":137.87,"10th_percentile":137.87,"90th_percentile":137.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"269","median_amount":122.1,"10th_percentile":97.59,"90th_percentile":222.66,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":100.0,"10th_percentile":100.0,"90th_percentile":186.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"133","median_amount":133.21,"10th_percentile":121.99,"90th_percentile":286.68,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"318","median_amount":124.48,"10th_percentile":23.44,"90th_percentile":201.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":771.3,"10th_percentile":771.3,"90th_percentile":771.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"362","median_amount":122.0,"10th_percentile":97.59,"90th_percentile":227.68,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":248.96,"10th_percentile":248.96,"90th_percentile":248.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":509.55,"10th_percentile":509.55,"90th_percentile":509.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":77.0,"10th_percentile":77.0,"90th_percentile":142.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":469.0,"10th_percentile":344.0,"90th_percentile":469.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":395.55,"10th_percentile":158.05,"90th_percentile":510.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":47.1,"10th_percentile":47.1,"90th_percentile":47.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":84.53,"10th_percentile":84.53,"90th_percentile":84.53,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":67.82,"10th_percentile":47.1,"90th_percentile":132.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":98.2,"10th_percentile":96.08,"90th_percentile":128.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":362.1,"10th_percentile":362.1,"90th_percentile":362.1},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":292.19,"10th_percentile":292.19,"90th_percentile":763.18},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":110.1,"10th_percentile":77.0,"90th_percentile":115.26,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":213.9,"10th_percentile":213.9,"90th_percentile":213.9,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":346.5,"10th_percentile":346.5,"90th_percentile":350.49,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":94.43,"10th_percentile":94.43,"90th_percentile":110.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":46.93,"10th_percentile":46.93,"90th_percentile":46.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":85.05,"10th_percentile":85.05,"90th_percentile":85.05,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1214.1,"10th_percentile":1214.1,"90th_percentile":1214.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":504.97,"10th_percentile":419.28,"90th_percentile":805.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"38","median_amount":152.4,"10th_percentile":44.26,"90th_percentile":154.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"85","median_amount":77.0,"10th_percentile":55.03,"90th_percentile":132.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":150.88,"10th_percentile":61.7,"90th_percentile":153.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"176","median_amount":643.4,"10th_percentile":282.58,"90th_percentile":653.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"97","median_amount":622.0,"10th_percentile":362.4,"90th_percentile":653.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":648.0,"10th_percentile":648.0,"90th_percentile":648.0,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"43","median_amount":77.0,"10th_percentile":57.81,"90th_percentile":110.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":567.51,"10th_percentile":300.0,"90th_percentile":1042.39},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"34","median_amount":77.0,"10th_percentile":57.81,"90th_percentile":154.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":152.7,"10th_percentile":140.0,"90th_percentile":292.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"1 through 10","median_amount":932.83,"10th_percentile":932.83,"90th_percentile":932.83},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":693.91,"10th_percentile":693.91,"90th_percentile":693.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":152.1,"10th_percentile":47.1,"90th_percentile":154.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"24","median_amount":91.43,"10th_percentile":68.19,"90th_percentile":149.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"159","median_amount":80.33,"10th_percentile":56.29,"90th_percentile":150.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"196","median_amount":101.53,"10th_percentile":86.78,"90th_percentile":188.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.92,"10th_percentile":119.92,"90th_percentile":119.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":750.06,"10th_percentile":750.06,"90th_percentile":750.06},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"108","median_amount":419.9,"10th_percentile":316.24,"90th_percentile":825.48},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"78","median_amount":77.0,"10th_percentile":65.89,"90th_percentile":132.26,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"24","median_amount":431.36,"10th_percentile":91.95,"90th_percentile":743.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"81","median_amount":497.95,"10th_percentile":297.95,"90th_percentile":966.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"103","median_amount":77.0,"10th_percentile":47.1,"90th_percentile":132.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"72","median_amount":136.09,"10th_percentile":47.1,"90th_percentile":153.26,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":152.96,"10th_percentile":152.96,"90th_percentile":155.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"42","median_amount":893.95,"10th_percentile":606.6,"90th_percentile":1502.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":535.56,"10th_percentile":67.14,"90th_percentile":879.09,"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":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"88","median_amount":913.8,"10th_percentile":484.18,"90th_percentile":2225.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"294","median_amount":267.47,"10th_percentile":157.47,"90th_percentile":508.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"1 through 10","median_amount":1105.29,"10th_percentile":212.21,"90th_percentile":5000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"188","median_amount":111.99,"10th_percentile":65.89,"90th_percentile":244.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"164","median_amount":263.9,"10th_percentile":173.9,"90th_percentile":487.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"735","median_amount":1437.0,"10th_percentile":806.56,"90th_percentile":1622.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"411","median_amount":1309.6,"10th_percentile":388.78,"90th_percentile":1637.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1496.0,"10th_percentile":883.25,"90th_percentile":1637.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"95","median_amount":92.46,"10th_percentile":57.81,"90th_percentile":313.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"61","median_amount":1258.0,"10th_percentile":573.92,"90th_percentile":2103.32},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"87","median_amount":112.91,"10th_percentile":63.33,"90th_percentile":248.91,"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":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":264.9,"10th_percentile":240.27,"90th_percentile":467.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":948.07,"10th_percentile":507.13,"90th_percentile":1692.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"222","median_amount":264.6,"10th_percentile":124.9,"90th_percentile":487.73,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"60","median_amount":120.94,"10th_percentile":68.97,"90th_percentile":274.72,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":267.45,"10th_percentile":167.27,"90th_percentile":569.42,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"439","median_amount":112.88,"10th_percentile":68.97,"90th_percentile":247.09,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"473","median_amount":130.85,"10th_percentile":97.54,"90th_percentile":287.68,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":300.32,"10th_percentile":209.68,"90th_percentile":459.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1142.55,"10th_percentile":1142.55,"90th_percentile":1142.55},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1591.2,"10th_percentile":1591.2,"90th_percentile":1591.2},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"463","median_amount":980.45,"10th_percentile":641.47,"90th_percentile":1977.9},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"209","median_amount":110.1,"10th_percentile":66.49,"90th_percentile":251.95,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"113","median_amount":802.92,"10th_percentile":431.31,"90th_percentile":2022.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":213.96,"10th_percentile":213.96,"90th_percentile":213.96},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"247","median_amount":1044.0,"10th_percentile":334.01,"90th_percentile":2123.66,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"232","median_amount":110.1,"10th_percentile":68.97,"90th_percentile":312.41,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"414","median_amount":264.61,"10th_percentile":154.3,"90th_percentile":484.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"107","median_amount":270.68,"10th_percentile":267.45,"90th_percentile":515.53,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"216","median_amount":1385.1,"10th_percentile":1005.3,"90th_percentile":2271.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"13","median_amount":758.44,"10th_percentile":310.61,"90th_percentile":1443.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"63","median_amount":2263.53,"10th_percentile":1441.35,"90th_percentile":6664.63,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"207","median_amount":685.87,"10th_percentile":403.08,"90th_percentile":1104.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"1 through 10","median_amount":8360.1,"10th_percentile":749.6,"90th_percentile":10000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"94","median_amount":335.56,"10th_percentile":128.85,"90th_percentile":532.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"139","median_amount":654.45,"10th_percentile":403.08,"90th_percentile":1079.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"427","median_amount":3168.76,"10th_percentile":1923.55,"90th_percentile":3371.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"242","median_amount":3038.0,"10th_percentile":1472.96,"90th_percentile":3272.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":3087.0,"10th_percentile":3087.0,"90th_percentile":3087.0,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"28","median_amount":242.58,"10th_percentile":124.38,"90th_percentile":497.15,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"39","median_amount":2853.03,"10th_percentile":1951.83,"90th_percentile":8005.15},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"35","median_amount":331.18,"10th_percentile":128.85,"90th_percentile":550.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":743.64,"10th_percentile":402.57,"90th_percentile":968.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":7733.56,"10th_percentile":6525.28,"90th_percentile":8675.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"142","median_amount":615.64,"10th_percentile":303.47,"90th_percentile":942.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"36","median_amount":334.37,"10th_percentile":121.23,"90th_percentile":606.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":557.21,"10th_percentile":381.37,"90th_percentile":843.24,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"136","median_amount":292.49,"10th_percentile":123.66,"90th_percentile":565.68,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"219","median_amount":343.01,"10th_percentile":112.73,"90th_percentile":604.91,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":789.2,"10th_percentile":661.54,"90th_percentile":1781.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3011.37,"10th_percentile":2692.09,"90th_percentile":6067.39},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"257","median_amount":2841.81,"10th_percentile":1476.58,"90th_percentile":6791.59},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"82","median_amount":296.42,"10th_percentile":120.87,"90th_percentile":553.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"103","median_amount":1840.72,"10th_percentile":1023.8,"90th_percentile":5520.99,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"149","median_amount":2858.96,"10th_percentile":1147.86,"90th_percentile":7206.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"75","median_amount":309.07,"10th_percentile":100.71,"90th_percentile":611.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"322","median_amount":688.36,"10th_percentile":395.95,"90th_percentile":988.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"84","median_amount":819.02,"10th_percentile":496.36,"90th_percentile":1095.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"40","median_amount":3242.8,"10th_percentile":1454.44,"90th_percentile":9331.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":4954.6,"10th_percentile":4954.6,"90th_percentile":4954.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"13","median_amount":8089.54,"10th_percentile":2589.88,"90th_percentile":12005.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"90","median_amount":1139.66,"10th_percentile":648.7,"90th_percentile":2544.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"1 through 10","median_amount":23502.15,"10th_percentile":23502.15,"90th_percentile":23502.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"32","median_amount":627.23,"10th_percentile":209.46,"90th_percentile":1051.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":2442.79,"10th_percentile":908.14,"90th_percentile":2616.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"126","median_amount":3370.99,"10th_percentile":2591.97,"90th_percentile":10370.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"71","median_amount":3272.0,"10th_percentile":1322.22,"90th_percentile":10478.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":670.2,"10th_percentile":571.33,"90th_percentile":1057.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"13","median_amount":6693.01,"10th_percentile":4930.95,"90th_percentile":15081.14},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":412.29,"10th_percentile":250.78,"90th_percentile":492.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":1281.55,"10th_percentile":571.21,"90th_percentile":2608.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":1164.73,"10th_percentile":666.22,"90th_percentile":2515.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"13","median_amount":533.48,"10th_percentile":305.32,"90th_percentile":1115.53,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2442.13,"10th_percentile":2442.13,"90th_percentile":2442.13,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"36","median_amount":486.1,"10th_percentile":192.75,"90th_percentile":1037.11,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"46","median_amount":483.32,"10th_percentile":172.67,"90th_percentile":914.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1885.38,"10th_percentile":968.0,"90th_percentile":2506.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"59","median_amount":6905.09,"10th_percentile":3144.29,"90th_percentile":14608.4},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"20","median_amount":590.01,"10th_percentile":249.35,"90th_percentile":1303.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"23","median_amount":5246.35,"10th_percentile":2019.69,"90th_percentile":10000.0,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"42","median_amount":5915.9,"10th_percentile":3416.21,"90th_percentile":16367.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"23","median_amount":437.54,"10th_percentile":211.78,"90th_percentile":1223.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"132","median_amount":1324.29,"10th_percentile":751.39,"90th_percentile":2599.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":1452.36,"10th_percentile":880.77,"90th_percentile":2652.63,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4761.4,"10th_percentile":4761.4,"90th_percentile":26519.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":15403.3,"10th_percentile":15403.3,"90th_percentile":15403.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"14","median_amount":1242.22,"10th_percentile":1136.83,"90th_percentile":5966.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3081.71,"10th_percentile":3081.71,"90th_percentile":3081.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1209.57,"10th_percentile":1209.49,"90th_percentile":2608.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"12","median_amount":5185.0,"10th_percentile":5184.99,"90th_percentile":10370.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":5239.0,"10th_percentile":4127.11,"90th_percentile":10278.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":609.71,"10th_percentile":609.71,"90th_percentile":609.71,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":4462.12,"10th_percentile":4462.12,"90th_percentile":4462.12},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1231.32,"10th_percentile":1231.32,"90th_percentile":1231.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2309.01,"10th_percentile":2309.01,"90th_percentile":2309.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":900.77,"10th_percentile":509.92,"90th_percentile":8079.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2536.22,"10th_percentile":2536.22,"90th_percentile":2536.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1375.18,"10th_percentile":1375.18,"90th_percentile":1375.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":299.23,"10th_percentile":262.41,"90th_percentile":843.09,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":17321.48,"10th_percentile":8886.48,"90th_percentile":23436.58},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":394.91,"10th_percentile":394.91,"90th_percentile":394.91,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":12512.59,"10th_percentile":12512.59,"90th_percentile":12512.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":11661.22,"10th_percentile":11661.22,"90th_percentile":12488.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"24","median_amount":1982.31,"10th_percentile":1209.51,"90th_percentile":2659.58,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1510.94,"10th_percentile":1267.58,"90th_percentile":2655.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":11750.47,"10th_percentile":11750.47,"90th_percentile":11750.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma Response with Critical Care","code_information":[{"code":"5045","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":2339.51,"10th_percentile":2339.51,"90th_percentile":2339.51,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"1 through 10","median_amount":18285.9,"10th_percentile":5030.65,"90th_percentile":47242.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":4148.11,"10th_percentile":4148.11,"90th_percentile":4148.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":5091.2,"10th_percentile":5091.2,"90th_percentile":5091.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2927.75,"10th_percentile":2927.75,"90th_percentile":2927.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8259.83,"10th_percentile":8259.83,"90th_percentile":8259.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":299.23,"10th_percentile":299.23,"90th_percentile":299.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":15974.88,"10th_percentile":15974.88,"90th_percentile":15974.88},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2864.44,"10th_percentile":2833.18,"90th_percentile":3511.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2992.04,"10th_percentile":2992.04,"90th_percentile":2992.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":31319.87,"10th_percentile":31319.87,"90th_percentile":31319.87,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":264.5,"10th_percentile":264.5,"90th_percentile":327.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":166.08,"10th_percentile":166.08,"90th_percentile":166.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":310.42,"10th_percentile":188.3,"90th_percentile":310.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"19","median_amount":1622.0,"10th_percentile":648.0,"90th_percentile":4834.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":1637.0,"10th_percentile":653.0,"90th_percentile":1637.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":163.59,"10th_percentile":163.59,"90th_percentile":163.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"1 through 10","median_amount":1485.78,"10th_percentile":1485.78,"90th_percentile":1485.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":1543.72,"10th_percentile":1543.72,"90th_percentile":1543.72},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":163.59,"10th_percentile":163.59,"90th_percentile":163.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":310.08,"10th_percentile":30.98,"90th_percentile":632.82,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":310.08,"10th_percentile":157.18,"90th_percentile":855.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":166.08,"10th_percentile":166.08,"90th_percentile":166.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":166.06,"10th_percentile":163.59,"90th_percentile":166.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":239.95,"10th_percentile":239.95,"90th_percentile":239.95,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1305.84,"10th_percentile":732.65,"90th_percentile":1555.05},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":166.08,"10th_percentile":160.6,"90th_percentile":166.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1351.26,"10th_percentile":1351.26,"90th_percentile":1351.26,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1586.33,"10th_percentile":1170.45,"90th_percentile":1614.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"17","median_amount":313.93,"10th_percentile":150.47,"90th_percentile":618.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":423.98,"10th_percentile":423.98,"90th_percentile":423.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"29","median_amount":1991.25,"10th_percentile":1383.8,"90th_percentile":2369.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":1579.25,"10th_percentile":1579.25,"90th_percentile":1579.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":642.79,"10th_percentile":530.59,"90th_percentile":858.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":379.54,"10th_percentile":379.54,"90th_percentile":379.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":510.39,"10th_percentile":246.18,"90th_percentile":631.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"22","median_amount":1622.0,"10th_percentile":1347.24,"90th_percentile":5652.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":661.32,"10th_percentile":653.0,"90th_percentile":1720.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1622.0,"10th_percentile":1622.0,"90th_percentile":1622.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":252.71,"10th_percentile":252.71,"90th_percentile":252.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":241.59,"10th_percentile":241.59,"90th_percentile":241.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":638.18,"10th_percentile":509.18,"90th_percentile":698.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":459.25,"10th_percentile":108.18,"90th_percentile":739.71,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":241.59,"10th_percentile":241.59,"90th_percentile":241.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":289.64,"10th_percentile":241.79,"90th_percentile":361.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":240.69,"10th_percentile":227.38,"90th_percentile":347.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"12","median_amount":1097.57,"10th_percentile":852.08,"90th_percentile":1304.6},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":241.59,"10th_percentile":241.59,"90th_percentile":252.71,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":5812.18,"10th_percentile":5812.18,"90th_percentile":5812.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1259.8,"10th_percentile":1137.16,"90th_percentile":1829.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":160.6,"10th_percentile":160.6,"90th_percentile":241.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"21","median_amount":532.49,"10th_percentile":198.0,"90th_percentile":743.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":653.36,"10th_percentile":648.96,"90th_percentile":653.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"19","median_amount":1574.1,"10th_percentile":703.35,"90th_percentile":2305.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":554.7,"10th_percentile":554.7,"90th_percentile":586.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1687.0,"10th_percentile":1687.0,"90th_percentile":3240.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":5652.0,"10th_percentile":5652.0,"90th_percentile":5652.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":357.95,"10th_percentile":357.95,"90th_percentile":357.95,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":488.73,"10th_percentile":488.73,"90th_percentile":488.73},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":121.23,"10th_percentile":121.23,"90th_percentile":121.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1033.17,"10th_percentile":1033.17,"90th_percentile":1033.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3162.48,"10th_percentile":3162.48,"90th_percentile":3162.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":1477.45,"10th_percentile":1443.43,"90th_percentile":1700.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":832.03,"10th_percentile":832.03,"90th_percentile":832.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2142.33,"10th_percentile":2142.33,"90th_percentile":2142.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":5501.38,"10th_percentile":5501.38,"90th_percentile":5501.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":7932.98,"10th_percentile":7932.98,"90th_percentile":7932.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1739.54,"10th_percentile":1739.54,"90th_percentile":1739.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":151.81,"10th_percentile":151.81,"90th_percentile":151.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":2367.16,"10th_percentile":2367.16,"90th_percentile":2367.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":668.58,"10th_percentile":376.92,"90th_percentile":671.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":788.79,"10th_percentile":672.02,"90th_percentile":855.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"11","median_amount":2623.3,"10th_percentile":1969.88,"90th_percentile":4492.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":3075.0,"10th_percentile":2503.31,"90th_percentile":4350.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":2726.65,"10th_percentile":2726.65,"90th_percentile":2726.65},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":863.12,"10th_percentile":396.01,"90th_percentile":884.77,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":673.02,"10th_percentile":445.01,"90th_percentile":967.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":430.53,"10th_percentile":421.21,"90th_percentile":430.53,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1634.32,"10th_percentile":1634.32,"90th_percentile":9177.96},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1975.79,"10th_percentile":1975.79,"90th_percentile":11741.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":81.52,"10th_percentile":81.52,"90th_percentile":81.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"12","median_amount":671.21,"10th_percentile":532.82,"90th_percentile":793.86,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":4562.04,"10th_percentile":2641.38,"90th_percentile":8497.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"23","median_amount":1539.22,"10th_percentile":1343.61,"90th_percentile":1619.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"1 through 10","median_amount":10.0,"10th_percentile":10.0,"90th_percentile":10.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":589.9,"10th_percentile":589.9,"90th_percentile":589.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1507.32,"10th_percentile":1226.98,"90th_percentile":1563.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"28","median_amount":4771.27,"10th_percentile":2134.0,"90th_percentile":13004.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"17","median_amount":4742.99,"10th_percentile":3758.24,"90th_percentile":5349.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":603.2,"10th_percentile":603.2,"90th_percentile":603.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":6604.58,"10th_percentile":6604.58,"90th_percentile":6604.58},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1542.72,"10th_percentile":1092.72,"90th_percentile":1631.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1238.72,"10th_percentile":1213.32,"90th_percentile":1541.72,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":589.77,"10th_percentile":589.77,"90th_percentile":589.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"18","median_amount":868.85,"10th_percentile":820.58,"90th_percentile":1148.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4141.52,"10th_percentile":4141.52,"90th_percentile":4141.52},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"17","median_amount":4222.04,"10th_percentile":387.51,"90th_percentile":12633.57},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":3347.61,"10th_percentile":3347.61,"90th_percentile":3347.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":6543.11,"10th_percentile":3675.76,"90th_percentile":23271.86,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":806.75,"10th_percentile":806.75,"90th_percentile":806.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"27","median_amount":1514.82,"10th_percentile":1126.0,"90th_percentile":1613.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1613.24,"10th_percentile":1613.24,"90th_percentile":1613.24,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5677.01,"10th_percentile":5677.01,"90th_percentile":30161.97,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":4155.49,"10th_percentile":4155.49,"90th_percentile":4155.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":17334.89,"10th_percentile":17334.89,"90th_percentile":17334.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":2565.4,"10th_percentile":2565.4,"90th_percentile":2715.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2573.85,"10th_percentile":2573.85,"90th_percentile":2644.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":11822.81,"10th_percentile":11187.22,"90th_percentile":16354.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8.9,"10th_percentile":8.9,"90th_percentile":8.9,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":954.07,"10th_percentile":954.07,"90th_percentile":954.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2643.15,"10th_percentile":2643.15,"90th_percentile":2643.15,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2415.22,"10th_percentile":2415.22,"90th_percentile":2415.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1102.66,"10th_percentile":1102.66,"90th_percentile":1260.78,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":20398.11,"10th_percentile":12424.21,"90th_percentile":33706.96},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":938.41,"10th_percentile":938.41,"90th_percentile":938.41,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":8788.13,"10th_percentile":8788.13,"90th_percentile":8788.13,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":12370.47,"10th_percentile":12370.47,"90th_percentile":15149.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":783.33,"10th_percentile":783.33,"90th_percentile":783.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2709.22,"10th_percentile":2709.22,"90th_percentile":3087.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3136.35,"10th_percentile":3136.35,"90th_percentile":3136.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":20507.06,"10th_percentile":20507.06,"90th_percentile":20507.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":5943.92,"10th_percentile":3630.3,"90th_percentile":6179.13,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3728.21,"10th_percentile":3728.21,"90th_percentile":3728.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":14878.41,"10th_percentile":12387.96,"90th_percentile":22627.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":10541.5,"10th_percentile":10355.49,"90th_percentile":12416.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3233.53,"10th_percentile":3233.53,"90th_percentile":3233.53,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2532.29,"10th_percentile":2532.29,"90th_percentile":2532.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2088.65,"10th_percentile":2081.07,"90th_percentile":3637.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":15024.76,"10th_percentile":11873.76,"90th_percentile":30902.77},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":28461.34,"10th_percentile":28461.34,"90th_percentile":28461.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":601.8,"10th_percentile":601.8,"90th_percentile":601.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3237.71,"10th_percentile":3237.71,"90th_percentile":3237.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":5884.71,"10th_percentile":5884.71,"90th_percentile":5884.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6095.76,"10th_percentile":6095.76,"90th_percentile":6095.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":30047.5,"10th_percentile":30047.5,"90th_percentile":30047.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6179.23,"10th_percentile":6179.23,"90th_percentile":6179.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2050.96,"10th_percentile":2050.96,"90th_percentile":2050.96,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":12532.46,"10th_percentile":12532.46,"90th_percentile":27206.45},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6182.62,"10th_percentile":6180.72,"90th_percentile":6268.42,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6406.85,"10th_percentile":6406.85,"90th_percentile":6406.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":24908.03,"10th_percentile":24908.03,"90th_percentile":24908.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":589.11,"10th_percentile":589.11,"90th_percentile":589.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":490.17,"10th_percentile":490.17,"90th_percentile":490.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":330.19,"10th_percentile":330.19,"90th_percentile":330.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.8,"10th_percentile":931.8,"90th_percentile":931.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":4521.6,"10th_percentile":4521.6,"90th_percentile":4521.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4217.0,"10th_percentile":4217.0,"90th_percentile":4217.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":330.12,"10th_percentile":330.12,"90th_percentile":330.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":466.48,"10th_percentile":466.48,"90th_percentile":466.48,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":585.24,"10th_percentile":585.24,"90th_percentile":585.24},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":617.3,"10th_percentile":617.3,"90th_percentile":617.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":6144.46,"10th_percentile":6144.46,"90th_percentile":11684.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":1521.45,"10th_percentile":1517.45,"90th_percentile":1521.88,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1514.95,"10th_percentile":1514.95,"90th_percentile":1521.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"14","median_amount":3371.0,"10th_percentile":2916.05,"90th_percentile":12547.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4052.25,"10th_percentile":3058.4,"90th_percentile":4743.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":330.19,"10th_percentile":330.19,"90th_percentile":330.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1517.45,"10th_percentile":1517.45,"90th_percentile":1517.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":323.9,"10th_percentile":323.9,"90th_percentile":323.9,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":208.92,"10th_percentile":208.92,"90th_percentile":208.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":822.53,"10th_percentile":466.48,"90th_percentile":1372.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":8280.51,"10th_percentile":8280.51,"90th_percentile":8280.51},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":330.19,"10th_percentile":330.19,"90th_percentile":1407.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1965.36,"10th_percentile":1965.36,"90th_percentile":1965.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":581.48,"10th_percentile":581.48,"90th_percentile":581.48,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1393.06,"10th_percentile":1393.06,"90th_percentile":1514.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5055.06,"10th_percentile":5055.06,"90th_percentile":6960.86,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":3077.25,"10th_percentile":2764.3,"90th_percentile":3077.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"1 through 10","median_amount":2407.44,"10th_percentile":2407.44,"90th_percentile":2407.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":947.31,"10th_percentile":947.31,"90th_percentile":947.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2644.6,"10th_percentile":2407.44,"90th_percentile":3134.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"20","median_amount":13528.0,"10th_percentile":12708.9,"90th_percentile":19439.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"11","median_amount":8433.0,"10th_percentile":6868.0,"90th_percentile":10541.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6576.26,"10th_percentile":6576.26,"90th_percentile":6576.26,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3071.95,"10th_percentile":3071.95,"90th_percentile":3071.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":945.24,"10th_percentile":945.24,"90th_percentile":945.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":932.42,"10th_percentile":932.42,"90th_percentile":932.42,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1348.59,"10th_percentile":1348.59,"90th_percentile":1373.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":15453.2,"10th_percentile":12996.86,"90th_percentile":19932.7},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2495.77,"10th_percentile":2495.77,"90th_percentile":2495.77,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":8846.54,"10th_percentile":8846.54,"90th_percentile":8846.54,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":11344.2,"10th_percentile":9876.02,"90th_percentile":22382.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2486.87,"10th_percentile":2309.1,"90th_percentile":2495.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3016.8,"10th_percentile":2635.93,"90th_percentile":3080.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3134.64,"10th_percentile":3134.64,"90th_percentile":3134.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":16444.82,"10th_percentile":16444.82,"90th_percentile":21116.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":22390.32,"10th_percentile":22390.32,"90th_percentile":22390.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":6768.89,"10th_percentile":6768.89,"90th_percentile":6963.86,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5647.15,"10th_percentile":5647.15,"90th_percentile":6528.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"14","median_amount":24188.75,"10th_percentile":21646.99,"90th_percentile":35185.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"12","median_amount":15502.0,"10th_percentile":14098.63,"90th_percentile":21786.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2071.86,"10th_percentile":2071.86,"90th_percentile":2071.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":38785.75,"10th_percentile":38785.75,"90th_percentile":38785.75},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6771.26,"10th_percentile":6771.26,"90th_percentile":6771.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6768.99,"10th_percentile":6370.86,"90th_percentile":6956.86,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2523.07,"10th_percentile":2523.07,"90th_percentile":4505.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4621.77,"10th_percentile":4621.77,"90th_percentile":4621.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":25910.74,"10th_percentile":25910.74,"90th_percentile":25910.74},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":23414.26,"10th_percentile":14820.76,"90th_percentile":29259.8},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":20086.04,"10th_percentile":20086.04,"90th_percentile":20086.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":22964.82,"10th_percentile":22184.69,"90th_percentile":28884.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6326.17,"10th_percentile":6326.17,"90th_percentile":6846.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"16","median_amount":28828.4,"10th_percentile":18450.8,"90th_percentile":37653.11,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"13","median_amount":12656.62,"10th_percentile":12434.5,"90th_percentile":12752.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12649.41,"10th_percentile":12486.75,"90th_percentile":12746.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"14","median_amount":17882.0,"10th_percentile":16409.49,"90th_percentile":21647.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":14758.0,"10th_percentile":14758.0,"90th_percentile":16108.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12281.24,"10th_percentile":12147.63,"90th_percentile":12412.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12376.58,"10th_percentile":12362.18,"90th_percentile":12435.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6325.28,"10th_percentile":6325.28,"90th_percentile":6325.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":29151.05,"10th_percentile":29025.06,"90th_percentile":31962.06},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4183.99,"10th_percentile":4183.99,"90th_percentile":4183.99,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":28104.04,"10th_percentile":28104.04,"90th_percentile":30544.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":32404.14,"10th_percentile":32404.14,"90th_percentile":35640.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4196.46,"10th_percentile":4196.46,"90th_percentile":4196.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10199.66,"10th_percentile":9942.01,"90th_percentile":12752.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12989.62,"10th_percentile":12989.62,"90th_percentile":12989.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":17151.79,"10th_percentile":17151.79,"90th_percentile":17509.78,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":22519.0,"10th_percentile":22519.0,"90th_percentile":22519.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17503.48,"10th_percentile":17503.48,"90th_percentile":17503.48,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4148.76,"10th_percentile":4148.76,"90th_percentile":4148.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":43428.73,"10th_percentile":43428.73,"90th_percentile":43428.73,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17161.88,"10th_percentile":17161.88,"90th_percentile":17161.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":317.22,"10th_percentile":317.22,"90th_percentile":317.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":111.76,"10th_percentile":111.76,"90th_percentile":111.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":195.51,"10th_percentile":171.1,"90th_percentile":268.69,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":12546.99,"10th_percentile":12546.99,"90th_percentile":12546.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":12018.76,"10th_percentile":12018.76,"90th_percentile":12018.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2792.06,"10th_percentile":2792.06,"90th_percentile":2792.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":3501.08,"10th_percentile":3501.08,"90th_percentile":3501.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":13528.03,"10th_percentile":13528.0,"90th_percentile":17849.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3497.07,"10th_percentile":3497.07,"90th_percentile":3497.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":820.89,"10th_percentile":820.89,"90th_percentile":820.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3186.61,"10th_percentile":3186.61,"90th_percentile":3186.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":15935.91,"10th_percentile":15935.91,"90th_percentile":15935.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":38147.89,"10th_percentile":26626.48,"90th_percentile":41545.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6558.82,"10th_percentile":6558.82,"90th_percentile":6558.82,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3390.48,"10th_percentile":3390.48,"90th_percentile":3390.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":570.95,"10th_percentile":570.95,"90th_percentile":570.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":21059.59,"10th_percentile":21059.59,"90th_percentile":21059.59},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3810.64,"10th_percentile":3810.64,"90th_percentile":3810.64,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":172.85,"10th_percentile":172.85,"90th_percentile":172.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2547.19,"10th_percentile":2547.19,"90th_percentile":2547.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6363.16,"10th_percentile":5826.1,"90th_percentile":6561.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":224.31,"10th_percentile":224.31,"90th_percentile":224.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":347.76,"10th_percentile":347.76,"90th_percentile":347.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":898.09,"10th_percentile":898.09,"90th_percentile":898.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":5567.51,"10th_percentile":5567.51,"90th_percentile":5567.51,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"17","median_amount":8618.35,"10th_percentile":7297.54,"90th_percentile":9604.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":7114.5,"10th_percentile":6403.05,"90th_percentile":7114.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":918.44,"10th_percentile":918.44,"90th_percentile":918.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":916.14,"10th_percentile":916.14,"90th_percentile":916.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"25","median_amount":1322.83,"10th_percentile":1294.2,"90th_percentile":1347.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":4700.26,"10th_percentile":3112.59,"90th_percentile":5753.76},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":610.9,"10th_percentile":610.9,"90th_percentile":610.9,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4960.88,"10th_percentile":4960.88,"90th_percentile":4960.88,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":6718.11,"10th_percentile":5970.05,"90th_percentile":7240.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":916.35,"10th_percentile":916.35,"90th_percentile":916.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":11926.26,"10th_percentile":11926.26,"90th_percentile":11926.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":3075.4,"10th_percentile":3075.4,"90th_percentile":3076.13,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":936.06,"10th_percentile":927.16,"90th_percentile":2276.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7705.81,"10th_percentile":7705.81,"90th_percentile":7705.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"26","median_amount":12547.01,"10th_percentile":9272.79,"90th_percentile":22406.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":7114.5,"10th_percentile":4268.7,"90th_percentile":14229.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":17709.6,"10th_percentile":17709.6,"90th_percentile":17709.6},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":877.7,"10th_percentile":877.7,"90th_percentile":877.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1162.55,"10th_percentile":1162.55,"90th_percentile":1162.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":868.8,"10th_percentile":868.8,"90th_percentile":935.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":1251.34,"10th_percentile":1224.25,"90th_percentile":1612.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":11146.86,"10th_percentile":8886.78,"90th_percentile":13539.05},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1385.34,"10th_percentile":1385.34,"90th_percentile":1385.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":10935.92,"10th_percentile":10759.29,"90th_percentile":12256.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":9744.82,"10th_percentile":8091.55,"90th_percentile":15848.24,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":936.06,"10th_percentile":936.06,"90th_percentile":936.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":607.9,"10th_percentile":607.9,"90th_percentile":607.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":12239.51,"10th_percentile":12239.51,"90th_percentile":12239.51,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":12464.56,"10th_percentile":12464.56,"90th_percentile":12464.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":5600.37,"10th_percentile":5600.37,"90th_percentile":5600.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":927.16,"10th_percentile":927.16,"90th_percentile":1385.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"32","median_amount":17044.9,"10th_percentile":15348.89,"90th_percentile":22536.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":8064.0,"10th_percentile":7502.74,"90th_percentile":16360.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":13144.92,"10th_percentile":13144.92,"90th_percentile":13144.92},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":927.16,"10th_percentile":927.16,"90th_percentile":927.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":6772.21,"10th_percentile":6772.21,"90th_percentile":6772.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5697.75,"10th_percentile":5697.75,"90th_percentile":5697.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":927.16,"10th_percentile":927.16,"90th_percentile":927.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"29","median_amount":1251.34,"10th_percentile":1224.25,"90th_percentile":1912.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15256.97,"10th_percentile":15256.97,"90th_percentile":15256.97},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":10765.62,"10th_percentile":9678.43,"90th_percentile":14746.12},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":10837.15,"10th_percentile":9736.54,"90th_percentile":11709.31,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"11","median_amount":11762.93,"10th_percentile":9805.59,"90th_percentile":13521.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":927.16,"10th_percentile":927.16,"90th_percentile":1375.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5444.5,"10th_percentile":5444.5,"90th_percentile":5444.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":865.75,"10th_percentile":590.75,"90th_percentile":1399.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":584.04,"10th_percentile":584.04,"90th_percentile":584.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":593.15,"10th_percentile":198.15,"90th_percentile":593.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":1470.49,"10th_percentile":1470.49,"90th_percentile":1488.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1181.39,"10th_percentile":1181.39,"90th_percentile":1181.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":5880.0,"10th_percentile":3436.09,"90th_percentile":13053.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1470.49,"10th_percentile":1470.49,"90th_percentile":1470.49,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":2164.28,"10th_percentile":2164.28,"90th_percentile":2164.28},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":2259.44,"10th_percentile":2259.44,"90th_percentile":2259.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1470.49,"10th_percentile":1470.49,"90th_percentile":1470.49,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":11104.9,"10th_percentile":11104.9,"90th_percentile":11104.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":2979.43,"10th_percentile":2764.93,"90th_percentile":3336.43,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2966.44,"10th_percentile":2830.54,"90th_percentile":2985.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":13528.01,"10th_percentile":6022.88,"90th_percentile":20292.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":8433.0,"10th_percentile":8433.0,"90th_percentile":12031.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2980.03,"10th_percentile":2980.03,"90th_percentile":2985.43,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1926.25,"10th_percentile":1926.25,"90th_percentile":1926.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1360.51,"10th_percentile":1360.51,"90th_percentile":1437.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":14864.28,"10th_percentile":10844.6,"90th_percentile":23010.94},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1567.44,"10th_percentile":1567.44,"90th_percentile":1567.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":20479.92,"10th_percentile":20479.92,"90th_percentile":20479.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":11644.22,"10th_percentile":11644.22,"90th_percentile":11644.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2963.42,"10th_percentile":2572.73,"90th_percentile":2979.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2322.84,"10th_percentile":2322.84,"90th_percentile":2322.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":6094.75,"10th_percentile":6094.75,"90th_percentile":6094.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"11","median_amount":3048.65,"10th_percentile":2740.39,"90th_percentile":3051.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1365.07,"10th_percentile":1365.07,"90th_percentile":1365.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3035.44,"10th_percentile":3032.59,"90th_percentile":5422.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":18391.84,"10th_percentile":16618.69,"90th_percentile":26017.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":21222.98,"10th_percentile":18258.39,"90th_percentile":22436.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":16146.25,"10th_percentile":16146.25,"90th_percentile":16146.25},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3045.45,"10th_percentile":3045.45,"90th_percentile":3045.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3050.65,"10th_percentile":3035.49,"90th_percentile":5313.86,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1423.22,"10th_percentile":1423.22,"90th_percentile":1423.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1488.04,"10th_percentile":1488.04,"90th_percentile":1488.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":17568.79,"10th_percentile":17568.79,"90th_percentile":20698.71},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1067.44,"10th_percentile":1067.44,"90th_percentile":1067.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"17","median_amount":3035.0,"10th_percentile":2435.72,"90th_percentile":3995.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3429.72,"10th_percentile":3429.72,"90th_percentile":3429.72,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":5397.07,"10th_percentile":5397.07,"90th_percentile":5402.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":25169.8,"10th_percentile":25169.8,"90th_percentile":25169.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":11362.0,"10th_percentile":11362.0,"90th_percentile":11362.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5404.07,"10th_percentile":5404.07,"90th_percentile":5404.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":34033.12,"10th_percentile":34033.12,"90th_percentile":34033.12},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4317.66,"10th_percentile":4317.66,"90th_percentile":5058.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5507.21,"10th_percentile":5507.21,"90th_percentile":10657.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":37247.1,"10th_percentile":37247.1,"90th_percentile":37247.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":10747.86,"10th_percentile":10740.5,"90th_percentile":11092.0,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4501.74,"10th_percentile":4501.74,"90th_percentile":4501.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":36015.77,"10th_percentile":35470.52,"90th_percentile":38087.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":26029.48,"10th_percentile":26029.48,"90th_percentile":26029.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":40575.95,"10th_percentile":40575.95,"90th_percentile":40575.95},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10735.0,"10th_percentile":10735.0,"90th_percentile":10744.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10741.0,"10th_percentile":10741.0,"90th_percentile":10741.0,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5458.99,"10th_percentile":5458.99,"90th_percentile":5458.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":38708.17,"10th_percentile":38708.17,"90th_percentile":38708.17},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4715.52,"10th_percentile":4715.52,"90th_percentile":4715.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":43063.32,"10th_percentile":43063.32,"90th_percentile":43063.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":52408.42,"10th_percentile":52408.42,"90th_percentile":52408.42,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10741.2,"10th_percentile":10741.2,"90th_percentile":10741.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10954.08,"10th_percentile":10954.08,"90th_percentile":10954.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16716.97,"10th_percentile":16716.97,"90th_percentile":16716.97,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":40940.0,"10th_percentile":40940.0,"90th_percentile":40940.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16605.85,"10th_percentile":16605.85,"90th_percentile":16605.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7841.96,"10th_percentile":7841.96,"90th_percentile":7841.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":9921.95,"10th_percentile":9921.95,"90th_percentile":9921.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7925.2,"10th_percentile":7925.2,"90th_percentile":7925.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9906.5,"10th_percentile":9906.5,"90th_percentile":9906.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9913.5,"10th_percentile":9913.5,"90th_percentile":9913.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9914.4,"10th_percentile":9914.4,"90th_percentile":9914.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":18058.29,"10th_percentile":18058.29,"90th_percentile":18058.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18485.15,"10th_percentile":18485.15,"90th_percentile":18485.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21254.6,"10th_percentile":21254.6,"90th_percentile":21254.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":30355.44,"10th_percentile":30355.44,"90th_percentile":30355.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":18819.0,"10th_percentile":18819.0,"90th_percentile":18819.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11105.87,"10th_percentile":11105.87,"90th_percentile":11105.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30349.54,"10th_percentile":30349.54,"90th_percentile":30349.54,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30349.55,"10th_percentile":30349.55,"90th_percentile":30349.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":1319.45,"10th_percentile":1319.45,"90th_percentile":1319.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":3371.0,"10th_percentile":3371.0,"90th_percentile":3371.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1724.23,"10th_percentile":1724.23,"90th_percentile":1724.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":758.92,"10th_percentile":758.92,"90th_percentile":758.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":5851.4,"10th_percentile":5227.92,"90th_percentile":6738.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"58","median_amount":887.5,"10th_percentile":846.2,"90th_percentile":1428.71,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":431.5,"10th_percentile":431.5,"90th_percentile":431.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":882.27,"10th_percentile":843.18,"90th_percentile":1019.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"51","median_amount":5652.0,"10th_percentile":4906.84,"90th_percentile":8478.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"26","median_amount":4217.0,"10th_percentile":3373.6,"90th_percentile":6325.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":8650.83,"10th_percentile":8650.83,"90th_percentile":8650.83},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":440.4,"10th_percentile":440.4,"90th_percentile":440.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":895.3,"10th_percentile":495.5,"90th_percentile":896.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":887.5,"10th_percentile":619.23,"90th_percentile":1270.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":431.5,"10th_percentile":431.5,"90th_percentile":431.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":440.31,"10th_percentile":431.41,"90th_percentile":864.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"33","median_amount":608.06,"10th_percentile":454.89,"90th_percentile":621.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":710.0,"10th_percentile":710.0,"90th_percentile":710.0,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5487.79,"10th_percentile":5487.79,"90th_percentile":5487.79},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"20","median_amount":5073.1,"10th_percentile":3437.47,"90th_percentile":6442.54},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":860.3,"10th_percentile":860.3,"90th_percentile":860.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":6294.43,"10th_percentile":4702.27,"90th_percentile":7565.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"20","median_amount":6266.3,"10th_percentile":2543.15,"90th_percentile":8325.68,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":435.95,"10th_percentile":431.06,"90th_percentile":860.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"68","median_amount":887.5,"10th_percentile":842.77,"90th_percentile":1039.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":933.51,"10th_percentile":905.61,"90th_percentile":1345.93,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":7476.9,"10th_percentile":7476.9,"90th_percentile":7476.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":6663.35,"10th_percentile":6663.35,"90th_percentile":6663.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":1776.28,"10th_percentile":1776.28,"90th_percentile":1801.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1501.69,"10th_percentile":1501.69,"90th_percentile":1501.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":9489.72,"10th_percentile":6332.31,"90th_percentile":12547.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4743.0,"10th_percentile":4743.0,"90th_percentile":4743.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":757.01,"10th_percentile":757.01,"90th_percentile":757.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1776.28,"10th_percentile":1436.55,"90th_percentile":1802.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":621.32,"10th_percentile":621.32,"90th_percentile":621.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":5035.61,"10th_percentile":5035.61,"90th_percentile":5035.61},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":6124.56,"10th_percentile":6124.56,"90th_percentile":6124.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":5556.19,"10th_percentile":5556.19,"90th_percentile":5556.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1795.7,"10th_percentile":1599.83,"90th_percentile":1891.24,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"11","median_amount":6195.64,"10th_percentile":5136.23,"90th_percentile":7204.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"35","median_amount":863.03,"10th_percentile":863.03,"90th_percentile":1139.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":437.7,"10th_percentile":437.7,"90th_percentile":437.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":863.03,"10th_percentile":849.71,"90th_percentile":863.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"108","median_amount":5652.0,"10th_percentile":5266.84,"90th_percentile":5880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"62","median_amount":4217.0,"10th_percentile":4217.0,"90th_percentile":4430.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":7537.24,"10th_percentile":5546.63,"90th_percentile":9170.09},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":433.25,"10th_percentile":433.25,"90th_percentile":433.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":863.03,"10th_percentile":849.71,"90th_percentile":1199.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":5018.89,"10th_percentile":5018.89,"90th_percentile":5018.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":863.03,"10th_percentile":863.03,"90th_percentile":863.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":440.29,"10th_percentile":440.29,"90th_percentile":853.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"20","median_amount":621.32,"10th_percentile":621.32,"90th_percentile":632.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4751.14,"10th_percentile":4751.14,"90th_percentile":4751.14},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"50","median_amount":5068.73,"10th_percentile":4496.31,"90th_percentile":6414.36},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":428.8,"10th_percentile":428.8,"90th_percentile":437.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"17","median_amount":5564.78,"10th_percentile":3872.24,"90th_percentile":6755.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"44","median_amount":5475.25,"10th_percentile":5010.2,"90th_percentile":6822.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":437.7,"10th_percentile":437.7,"90th_percentile":437.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"40","median_amount":863.03,"10th_percentile":849.71,"90th_percentile":863.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":880.64,"10th_percentile":880.64,"90th_percentile":907.77,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"22","median_amount":6418.65,"10th_percentile":5065.2,"90th_percentile":7822.73,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"133","median_amount":1116.12,"10th_percentile":1097.11,"90th_percentile":1674.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":433.25,"10th_percentile":428.8,"90th_percentile":869.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":1116.13,"10th_percentile":1097.11,"90th_percentile":1561.48,"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":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"245","median_amount":9255.9,"10th_percentile":7406.42,"90th_percentile":11816.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"120","median_amount":4743.0,"10th_percentile":4454.22,"90th_percentile":7114.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":9676.82,"10th_percentile":9676.82,"90th_percentile":9676.82,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":437.7,"10th_percentile":437.7,"90th_percentile":437.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"17","median_amount":7619.58,"10th_percentile":5876.9,"90th_percentile":9285.03},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":440.29,"10th_percentile":440.29,"90th_percentile":440.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":1116.12,"10th_percentile":1097.11,"90th_percentile":1559.86,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":5714.64,"10th_percentile":5714.64,"90th_percentile":5714.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":1116.12,"10th_percentile":1097.11,"90th_percentile":1559.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":860.3,"10th_percentile":860.3,"90th_percentile":860.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1518.49,"10th_percentile":1518.49,"90th_percentile":1518.49,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":437.61,"10th_percentile":428.71,"90th_percentile":864.57,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"46","median_amount":621.32,"10th_percentile":607.87,"90th_percentile":632.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1239.58,"10th_percentile":1239.58,"90th_percentile":1465.68,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":6665.34,"10th_percentile":6665.34,"90th_percentile":6665.34},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":695.0,"10th_percentile":695.0,"90th_percentile":695.0},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"81","median_amount":5262.48,"10th_percentile":4681.12,"90th_percentile":6745.88},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":441.02,"10th_percentile":428.8,"90th_percentile":442.15,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"42","median_amount":5054.54,"10th_percentile":4596.34,"90th_percentile":7050.0,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"59","median_amount":5909.84,"10th_percentile":4762.81,"90th_percentile":7741.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":440.29,"10th_percentile":433.25,"90th_percentile":1293.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"91","median_amount":1116.13,"10th_percentile":1097.11,"90th_percentile":1674.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":1138.9,"10th_percentile":1138.9,"90th_percentile":1708.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":5713.94,"10th_percentile":5713.94,"90th_percentile":8942.42,"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":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":8716.79,"10th_percentile":8716.79,"90th_percentile":8716.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":2710.82,"10th_percentile":2615.91,"90th_percentile":2991.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":989.16,"10th_percentile":989.16,"90th_percentile":989.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2497.31,"10th_percentile":2497.31,"90th_percentile":2497.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"15","median_amount":12982.66,"10th_percentile":12118.01,"90th_percentile":15373.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4743.0,"10th_percentile":4743.0,"90th_percentile":4743.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":715.74,"10th_percentile":715.74,"90th_percentile":715.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":984.71,"10th_percentile":984.71,"90th_percentile":984.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1418.27,"10th_percentile":1418.27,"90th_percentile":1444.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":12334.12,"10th_percentile":12334.12,"90th_percentile":12334.12},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":10898.2,"10th_percentile":10898.2,"90th_percentile":10898.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":631.89,"10th_percentile":631.89,"90th_percentile":631.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2610.41,"10th_percentile":2595.96,"90th_percentile":2793.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":22914.36,"10th_percentile":22914.36,"90th_percentile":22914.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":3341.59,"10th_percentile":3341.59,"90th_percentile":3341.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1906.68,"10th_percentile":1906.68,"90th_percentile":1906.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3229.59,"10th_percentile":3229.59,"90th_percentile":3229.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":13528.0,"10th_percentile":13528.0,"90th_percentile":27056.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":8433.0,"10th_percentile":8433.0,"90th_percentile":8433.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1906.68,"10th_percentile":1906.68,"90th_percentile":1906.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2720.14,"10th_percentile":2720.14,"90th_percentile":2809.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":12359.09,"10th_percentile":12359.09,"90th_percentile":21971.06},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":13622.75,"10th_percentile":12957.16,"90th_percentile":14114.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3222.36,"10th_percentile":3222.36,"90th_percentile":3222.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":6301.94,"10th_percentile":6301.94,"90th_percentile":6301.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":14073.01,"10th_percentile":12972.59,"90th_percentile":38455.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":8433.0,"10th_percentile":8433.0,"90th_percentile":13678.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5915.56,"10th_percentile":5915.56,"90th_percentile":5915.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2661.26,"10th_percentile":2661.26,"90th_percentile":2661.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":16943.62,"10th_percentile":16943.62,"90th_percentile":16943.62},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":14147.38,"10th_percentile":14147.38,"90th_percentile":26398.26,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1915.58,"10th_percentile":1915.58,"90th_percentile":1915.58,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5913.56,"10th_percentile":5913.56,"90th_percentile":7039.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7618.67,"10th_percentile":7618.67,"90th_percentile":7618.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":23971.33,"10th_percentile":23857.28,"90th_percentile":25693.13,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"17","median_amount":5528.72,"10th_percentile":5253.32,"90th_percentile":5917.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2388.52,"10th_percentile":2388.52,"90th_percentile":2388.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5529.2,"10th_percentile":5319.8,"90th_percentile":10255.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"30","median_amount":13176.0,"10th_percentile":12101.44,"90th_percentile":27232.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":27982.24,"10th_percentile":26531.66,"90th_percentile":44260.87},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":23409.55,"10th_percentile":23409.55,"90th_percentile":23409.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5528.82,"10th_percentile":5149.79,"90th_percentile":5917.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2743.31,"10th_percentile":2743.31,"90th_percentile":2743.31,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2493.24,"10th_percentile":2376.48,"90th_percentile":3237.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"15","median_amount":2719.96,"10th_percentile":2164.69,"90th_percentile":2783.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"30","median_amount":21650.22,"10th_percentile":14125.66,"90th_percentile":33183.76},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1906.68,"10th_percentile":1906.68,"90th_percentile":2207.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":22713.24,"10th_percentile":16758.61,"90th_percentile":25006.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"23","median_amount":22055.34,"10th_percentile":18433.98,"90th_percentile":27170.72,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1572.52,"10th_percentile":1570.62,"90th_percentile":1906.68,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"19","median_amount":5530.32,"10th_percentile":5219.02,"90th_percentile":5906.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":21697.2,"10th_percentile":21697.2,"90th_percentile":37107.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":9014.87,"10th_percentile":9014.87,"90th_percentile":9014.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":48692.87,"10th_percentile":48692.87,"90th_percentile":48692.87,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":9575.58,"10th_percentile":9575.58,"90th_percentile":9575.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2808.6,"10th_percentile":2808.6,"90th_percentile":2808.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":17882.02,"10th_percentile":17882.0,"90th_percentile":20708.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":16164.0,"10th_percentile":16164.0,"90th_percentile":22751.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":38902.52,"10th_percentile":38902.52,"90th_percentile":62788.57},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9414.28,"10th_percentile":9414.28,"90th_percentile":9414.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2522.07,"10th_percentile":2522.07,"90th_percentile":2529.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3966.84,"10th_percentile":3741.25,"90th_percentile":5459.11,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":27547.03,"10th_percentile":23924.99,"90th_percentile":38395.9},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2540.89,"10th_percentile":2540.89,"90th_percentile":2701.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9570.09,"10th_percentile":9570.09,"90th_percentile":9570.09,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10057.1,"10th_percentile":10057.1,"90th_percentile":10057.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":712.24,"10th_percentile":712.24,"90th_percentile":712.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":495.3,"10th_percentile":3.17,"90th_percentile":825.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":3584.43,"10th_percentile":3584.43,"90th_percentile":3584.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":640.83,"10th_percentile":640.83,"90th_percentile":640.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":633.76,"10th_percentile":337.83,"90th_percentile":641.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":11406.84,"10th_percentile":11406.84,"90th_percentile":11406.84},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":640.13,"10th_percentile":640.13,"90th_percentile":963.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":1939.13,"10th_percentile":1939.13,"90th_percentile":1945.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1941.13,"10th_percentile":1941.13,"90th_percentile":1941.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":12037.69,"10th_percentile":11638.96,"90th_percentile":13053.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4743.0,"10th_percentile":4743.0,"90th_percentile":5001.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1718.23,"10th_percentile":1718.23,"90th_percentile":1718.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":905.7,"10th_percentile":905.7,"90th_percentile":905.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1899.63,"10th_percentile":1645.13,"90th_percentile":1945.13,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":981.67,"10th_percentile":923.13,"90th_percentile":1268.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":11455.22,"10th_percentile":9630.26,"90th_percentile":16203.1},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":11234.26,"10th_percentile":11234.26,"90th_percentile":11234.26,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1939.13,"10th_percentile":1551.3,"90th_percentile":1948.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1978.7,"10th_percentile":1978.7,"90th_percentile":1978.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":14177.87,"10th_percentile":14177.87,"90th_percentile":14177.87,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"16","median_amount":3264.8,"10th_percentile":2995.3,"90th_percentile":8760.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3270.7,"10th_percentile":3244.4,"90th_percentile":3565.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"13","median_amount":13053.0,"10th_percentile":5651.98,"90th_percentile":13528.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":9598.62,"10th_percentile":9598.62,"90th_percentile":13042.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3272.8,"10th_percentile":3272.8,"90th_percentile":3272.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3267.2,"10th_percentile":3241.09,"90th_percentile":3514.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1303.21,"10th_percentile":1303.21,"90th_percentile":1496.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":665.06,"10th_percentile":665.06,"90th_percentile":665.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":981.67,"10th_percentile":981.67,"90th_percentile":999.71,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":12305.25,"10th_percentile":11661.28,"90th_percentile":31162.55},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":17889.31,"10th_percentile":17889.31,"90th_percentile":17889.31,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":16769.94,"10th_percentile":16769.94,"90th_percentile":17649.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1012.78,"10th_percentile":1012.78,"90th_percentile":1012.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3265.81,"10th_percentile":2611.84,"90th_percentile":7002.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3333.43,"10th_percentile":3333.43,"90th_percentile":3333.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":52120.59,"10th_percentile":52120.59,"90th_percentile":52120.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":4816.5,"10th_percentile":4541.1,"90th_percentile":5224.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4818.16,"10th_percentile":4519.63,"90th_percentile":4910.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"19","median_amount":17649.0,"10th_percentile":17462.19,"90th_percentile":18591.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":8960.0,"10th_percentile":8960.0,"90th_percentile":17649.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":31657.03,"10th_percentile":31657.03,"90th_percentile":31657.03},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4820.16,"10th_percentile":4814.66,"90th_percentile":4821.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4946.34,"10th_percentile":4810.01,"90th_percentile":5184.9,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2603.21,"10th_percentile":2603.21,"90th_percentile":2798.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"12","median_amount":20058.05,"10th_percentile":17957.82,"90th_percentile":28761.06},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":19609.2,"10th_percentile":19609.2,"90th_percentile":19609.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":19077.28,"10th_percentile":17965.51,"90th_percentile":24572.72,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"23","median_amount":4816.71,"10th_percentile":3984.75,"90th_percentile":5033.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4911.37,"10th_percentile":4911.37,"90th_percentile":4911.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":38937.87,"10th_percentile":38937.87,"90th_percentile":38937.87,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8499.37,"10th_percentile":8499.37,"90th_percentile":8499.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":18535.53,"10th_percentile":18535.53,"90th_percentile":18535.53,"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":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":42274.52,"10th_percentile":42274.52,"90th_percentile":42274.52},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":691.86,"10th_percentile":691.86,"90th_percentile":691.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":88.12,"10th_percentile":88.12,"90th_percentile":367.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":152.34,"10th_percentile":152.34,"90th_percentile":274.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"34","median_amount":722.7,"10th_percentile":470.45,"90th_percentile":933.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":794.64,"10th_percentile":746.48,"90th_percentile":2644.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":88.12,"10th_percentile":84.84,"90th_percentile":187.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":454.5,"10th_percentile":213.03,"90th_percentile":1468.88},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":84.73,"10th_percentile":84.73,"90th_percentile":84.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":111.58,"10th_percentile":111.58,"90th_percentile":128.82,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":84.82,"10th_percentile":84.73,"90th_percentile":87.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"46","median_amount":122.02,"10th_percentile":119.38,"90th_percentile":206.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":602.21,"10th_percentile":600.67,"90th_percentile":1379.49},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":175.41,"10th_percentile":175.41,"90th_percentile":175.41,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":2478.84,"10th_percentile":2478.84,"90th_percentile":2478.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":704.08,"10th_percentile":572.79,"90th_percentile":2022.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":87.16,"10th_percentile":84.84,"90th_percentile":295.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":222.67,"10th_percentile":222.67,"90th_percentile":414.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":702.0,"10th_percentile":702.0,"90th_percentile":702.0,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":113.06,"10th_percentile":113.06,"90th_percentile":113.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":661.97,"10th_percentile":661.97,"90th_percentile":661.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":415.82,"10th_percentile":415.82,"90th_percentile":415.82,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":763.51,"10th_percentile":763.51,"90th_percentile":763.51,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":13950.45,"10th_percentile":10636.04,"90th_percentile":17743.78,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":2912.48,"10th_percentile":2912.48,"90th_percentile":2912.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1102.92,"10th_percentile":1102.92,"90th_percentile":1229.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2859.9,"10th_percentile":2859.9,"90th_percentile":2859.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"26","median_amount":12546.98,"10th_percentile":9517.66,"90th_percentile":13053.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4743.0,"10th_percentile":3567.84,"90th_percentile":12803.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1027.3,"10th_percentile":1027.3,"90th_percentile":1027.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":22900.03,"10th_percentile":22900.03,"90th_percentile":22900.03},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1021.81,"10th_percentile":1021.81,"90th_percentile":1021.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3009.75,"10th_percentile":3009.75,"90th_percentile":3009.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1027.3,"10th_percentile":1027.3,"90th_percentile":1027.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1251.63,"10th_percentile":1251.63,"90th_percentile":8341.71,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1465.31,"10th_percentile":1433.6,"90th_percentile":1794.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":12336.64,"10th_percentile":11840.58,"90th_percentile":13223.16},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1027.3,"10th_percentile":1027.3,"90th_percentile":1036.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":7135.67,"10th_percentile":7135.67,"90th_percentile":7135.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":14495.67,"10th_percentile":14495.67,"90th_percentile":14514.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2708.74,"10th_percentile":2666.75,"90th_percentile":2913.09,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1027.3,"10th_percentile":1027.3,"90th_percentile":1027.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":17532.98,"10th_percentile":16814.0,"90th_percentile":17649.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":9779.25,"10th_percentile":9779.25,"90th_percentile":9779.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":14973.24,"10th_percentile":14973.24,"90th_percentile":14973.24},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1795.64,"10th_percentile":1795.64,"90th_percentile":1795.64,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1027.07,"10th_percentile":1027.07,"90th_percentile":1027.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1548.17,"10th_percentile":1548.17,"90th_percentile":1548.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":22145.44,"10th_percentile":22145.44,"90th_percentile":22145.44},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":13610.24,"10th_percentile":13610.24,"90th_percentile":13610.24,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4632.16,"10th_percentile":4632.16,"90th_percentile":4632.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":8795.86,"10th_percentile":8795.86,"90th_percentile":13428.09,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"23","median_amount":1854.0,"10th_percentile":1505.95,"90th_percentile":1856.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":598.29,"10th_percentile":598.29,"90th_percentile":598.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1850.39,"10th_percentile":1850.39,"90th_percentile":1855.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"23","median_amount":14546.36,"10th_percentile":11852.46,"90th_percentile":17933.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"11","median_amount":7114.5,"10th_percentile":4268.72,"90th_percentile":18147.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":584.72,"10th_percentile":584.72,"90th_percentile":584.72,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":11025.1,"10th_percentile":11025.1,"90th_percentile":11025.1},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1857.5,"10th_percentile":1856.5,"90th_percentile":1857.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1854.5,"10th_percentile":1854.5,"90th_percentile":1856.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1680.36,"10th_percentile":1680.36,"90th_percentile":1680.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1862.44,"10th_percentile":1862.44,"90th_percentile":1862.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":848.88,"10th_percentile":830.51,"90th_percentile":864.48,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":9344.86,"10th_percentile":8988.76,"90th_percentile":12360.07},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":11827.94,"10th_percentile":11827.94,"90th_percentile":11827.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":8960.5,"10th_percentile":8960.5,"90th_percentile":11918.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1855.5,"10th_percentile":1544.7,"90th_percentile":1857.87,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1886.22,"10th_percentile":1886.22,"90th_percentile":1886.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":12864.35,"10th_percentile":12864.35,"90th_percentile":12864.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":1703.89,"10th_percentile":1703.89,"90th_percentile":1703.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"11","median_amount":289.63,"10th_percentile":155.21,"90th_percentile":429.64,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":229.99,"10th_percentile":229.99,"90th_percentile":230.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":280.98,"10th_percentile":9.41,"90th_percentile":513.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"12","median_amount":2945.75,"10th_percentile":2711.95,"90th_percentile":3171.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"12","median_amount":1637.0,"10th_percentile":653.0,"90th_percentile":2961.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":57.81,"10th_percentile":57.81,"90th_percentile":229.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":2285.14,"10th_percentile":2285.14,"90th_percentile":2461.78},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":161.63,"10th_percentile":161.63,"90th_percentile":161.63,"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":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":300.72,"10th_percentile":289.4,"90th_percentile":1106.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":240.25,"10th_percentile":28.52,"90th_percentile":669.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":229.99,"10th_percentile":229.99,"90th_percentile":229.99,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":229.93,"10th_percentile":106.44,"90th_percentile":332.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":158.06,"10th_percentile":155.21,"90th_percentile":338.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1962.33,"10th_percentile":918.97,"90th_percentile":2130.52},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":229.99,"10th_percentile":229.99,"90th_percentile":229.99,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4569.63,"10th_percentile":4569.63,"90th_percentile":4569.63,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1133.13,"10th_percentile":798.64,"90th_percentile":1739.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":229.99,"10th_percentile":229.99,"90th_percentile":288.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"24","median_amount":335.32,"10th_percentile":223.54,"90th_percentile":575.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":303.27,"10th_percentile":303.27,"90th_percentile":303.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3009.29,"10th_percentile":3009.29,"90th_percentile":3009.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":655.54,"10th_percentile":373.43,"90th_percentile":987.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":777.61,"10th_percentile":777.61,"90th_percentile":777.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":524.44,"10th_percentile":524.44,"90th_percentile":528.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":2243.54,"10th_percentile":1809.74,"90th_percentile":2827.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4762.15,"10th_percentile":4762.15,"90th_percentile":4762.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":1660.11,"10th_percentile":1660.11,"90th_percentile":1660.11},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":668.13,"10th_percentile":654.87,"90th_percentile":673.71,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":655.54,"10th_percentile":348.93,"90th_percentile":670.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":425.17,"10th_percentile":425.17,"90th_percentile":425.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":481.65,"10th_percentile":294.58,"90th_percentile":801.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1674.0,"10th_percentile":1367.49,"90th_percentile":4797.22},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1293.08,"10th_percentile":1287.33,"90th_percentile":1382.88,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1448.43,"10th_percentile":1448.43,"90th_percentile":1709.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":191.6,"10th_percentile":191.6,"90th_percentile":191.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"19","median_amount":528.18,"10th_percentile":363.45,"90th_percentile":988.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3374.74,"10th_percentile":3374.74,"90th_percentile":3374.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2953.79,"10th_percentile":2953.79,"90th_percentile":2953.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":3077.94,"10th_percentile":2114.97,"90th_percentile":5370.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"59","median_amount":853.46,"10th_percentile":577.91,"90th_percentile":1269.62,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":327.69,"10th_percentile":327.69,"90th_percentile":327.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1011.3,"10th_percentile":724.18,"90th_percentile":1264.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"36","median_amount":5340.35,"10th_percentile":3717.9,"90th_percentile":7667.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"26","median_amount":6134.8,"10th_percentile":3269.16,"90th_percentile":8036.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":491.53,"10th_percentile":327.69,"90th_percentile":501.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":334.39,"10th_percentile":334.39,"90th_percentile":334.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":851.75,"10th_percentile":850.75,"90th_percentile":1273.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":4384.22,"10th_percentile":4384.22,"90th_percentile":4384.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":980.35,"10th_percentile":481.65,"90th_percentile":1270.13,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":491.53,"10th_percentile":491.53,"90th_percentile":491.53,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":982.84,"10th_percentile":982.84,"90th_percentile":983.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"23","median_amount":481.65,"10th_percentile":471.22,"90th_percentile":490.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":906.43,"10th_percentile":906.43,"90th_percentile":906.43},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":2443.38,"10th_percentile":1427.28,"90th_percentile":3823.7},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":655.38,"10th_percentile":655.38,"90th_percentile":655.38,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":2503.16,"10th_percentile":1464.52,"90th_percentile":4161.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":2542.71,"10th_percentile":1794.86,"90th_percentile":4657.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":491.53,"10th_percentile":491.53,"90th_percentile":501.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"48","median_amount":850.66,"10th_percentile":674.2,"90th_percentile":1272.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1329.67,"10th_percentile":1329.67,"90th_percentile":1329.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3948.44,"10th_percentile":2183.59,"90th_percentile":11808.68,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":275.0,"10th_percentile":275.0,"90th_percentile":275.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":20029.8,"10th_percentile":20029.8,"90th_percentile":20029.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8321.32,"10th_percentile":8321.32,"90th_percentile":8321.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":10155.85,"10th_percentile":10155.85,"90th_percentile":10155.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"177","median_amount":2164.44,"10th_percentile":1889.44,"90th_percentile":2172.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":751.57,"10th_percentile":751.57,"90th_percentile":760.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":2164.44,"10th_percentile":1869.84,"90th_percentile":2203.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"55","median_amount":12547.0,"10th_percentile":11350.25,"90th_percentile":12547.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"16","median_amount":4743.0,"10th_percentile":4341.95,"90th_percentile":5434.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":11110.11,"10th_percentile":11110.11,"90th_percentile":11175.12},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2167.94,"10th_percentile":1717.94,"90th_percentile":2173.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":2165.94,"10th_percentile":2023.15,"90th_percentile":2172.54,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":751.11,"10th_percentile":751.11,"90th_percentile":751.11,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":750.95,"10th_percentile":747.12,"90th_percentile":756.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":1076.07,"10th_percentile":1076.07,"90th_percentile":1095.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":9392.86,"10th_percentile":9392.86,"90th_percentile":9438.04},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":742.21,"10th_percentile":742.21,"90th_percentile":742.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"13","median_amount":9727.94,"10th_percentile":9079.32,"90th_percentile":11049.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"60","median_amount":2158.94,"10th_percentile":1727.15,"90th_percentile":2172.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"55","median_amount":2203.0,"10th_percentile":2203.0,"90th_percentile":2270.88,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Intraocular Procedures","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":4424.42,"10th_percentile":4424.42,"90th_percentile":4424.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"1 through 10","median_amount":17634.16,"10th_percentile":17634.16,"90th_percentile":17634.16},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4418.94,"10th_percentile":4418.94,"90th_percentile":4418.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Intraocular Procedures","code_information":[{"code":"5493","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"14","median_amount":4889.69,"10th_percentile":4864.69,"90th_percentile":4889.69,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4890.09,"10th_percentile":4890.09,"90th_percentile":4890.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":17649.0,"10th_percentile":17649.0,"90th_percentile":17649.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4866.12,"10th_percentile":4866.12,"90th_percentile":4866.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4590.19,"10th_percentile":4565.12,"90th_percentile":4894.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4893.1,"10th_percentile":4893.1,"90th_percentile":4893.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5137.42,"10th_percentile":5137.42,"90th_percentile":5137.42,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":418.5,"10th_percentile":418.5,"90th_percentile":418.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":64.9,"10th_percentile":64.9,"90th_percentile":64.9,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":435.38,"10th_percentile":435.38,"90th_percentile":435.38,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":275.0,"10th_percentile":275.0,"90th_percentile":275.0,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":11051.43,"10th_percentile":11051.43,"90th_percentile":14022.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":10664.95,"10th_percentile":9486.0,"90th_percentile":12547.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2069.86,"10th_percentile":2069.86,"90th_percentile":2069.86,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1390.43,"10th_percentile":1390.43,"90th_percentile":1390.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1958.99,"10th_percentile":1958.99,"90th_percentile":2002.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":8178.91,"10th_percentile":8178.91,"90th_percentile":8178.91},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1772.29,"10th_percentile":1772.29,"90th_percentile":1772.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5504","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1335.1,"10th_percentile":1335.1,"90th_percentile":1335.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"25","median_amount":1247.02,"10th_percentile":278.16,"90th_percentile":1936.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"87","median_amount":177.0,"10th_percentile":85.05,"90th_percentile":485.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"18","median_amount":83.87,"10th_percentile":24.58,"90th_percentile":136.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":211.31,"10th_percentile":100.0,"90th_percentile":547.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"215","median_amount":1352.5,"10th_percentile":583.21,"90th_percentile":1622.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"85","median_amount":1248.45,"10th_percentile":228.25,"90th_percentile":2224.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1238.8,"10th_percentile":1238.8,"90th_percentile":1238.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":133.55,"10th_percentile":90.36,"90th_percentile":197.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":1502.12,"10th_percentile":788.95,"90th_percentile":3121.3},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":79.16,"10th_percentile":46.83,"90th_percentile":157.63,"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":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":306.68,"10th_percentile":142.28,"90th_percentile":638.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":185.9,"10th_percentile":86.21,"90th_percentile":377.43,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":100.42,"10th_percentile":77.0,"90th_percentile":111.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":374.64,"10th_percentile":374.64,"90th_percentile":374.64,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"26","median_amount":84.49,"10th_percentile":23.87,"90th_percentile":172.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"77","median_amount":114.07,"10th_percentile":68.91,"90th_percentile":166.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":151.21,"10th_percentile":151.21,"90th_percentile":151.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":561.56,"10th_percentile":561.56,"90th_percentile":561.56},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"93","median_amount":1111.44,"10th_percentile":166.96,"90th_percentile":1725.71},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":135.18,"10th_percentile":77.0,"90th_percentile":248.69,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"15","median_amount":502.4,"10th_percentile":99.2,"90th_percentile":1821.86,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"70","median_amount":983.0,"10th_percentile":193.6,"90th_percentile":1658.05,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":110.66,"10th_percentile":46.83,"90th_percentile":206.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"101","median_amount":198.85,"10th_percentile":85.05,"90th_percentile":503.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":352.5,"10th_percentile":330.62,"90th_percentile":654.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1572.34,"10th_percentile":1432.08,"90th_percentile":2012.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":1535.17,"10th_percentile":1535.17,"90th_percentile":1535.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"29","median_amount":993.85,"10th_percentile":468.05,"90th_percentile":2626.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"325","median_amount":101.08,"10th_percentile":98.72,"90th_percentile":104.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"19","median_amount":47.84,"10th_percentile":45.72,"90th_percentile":121.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"87","median_amount":102.22,"10th_percentile":95.63,"90th_percentile":206.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":869.0,"10th_percentile":869.0,"90th_percentile":869.0,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":46.83,"10th_percentile":45.72,"90th_percentile":133.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"23","median_amount":851.26,"10th_percentile":666.65,"90th_percentile":1621.69},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":767.42,"10th_percentile":767.42,"90th_percentile":954.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"127","median_amount":102.72,"10th_percentile":100.67,"90th_percentile":216.9,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":47.84,"10th_percentile":46.83,"90th_percentile":75.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":81.77,"10th_percentile":80.54,"90th_percentile":104.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"36","median_amount":46.82,"10th_percentile":45.71,"90th_percentile":111.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"167","median_amount":68.91,"10th_percentile":67.28,"90th_percentile":113.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":69.6,"10th_percentile":48.27,"90th_percentile":774.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":376.47,"10th_percentile":376.47,"90th_percentile":376.47},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"138","median_amount":874.07,"10th_percentile":373.03,"90th_percentile":1953.73},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"20","median_amount":47.84,"10th_percentile":45.72,"90th_percentile":216.88,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"49","median_amount":849.28,"10th_percentile":284.8,"90th_percentile":2087.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"110","median_amount":526.0,"10th_percentile":420.8,"90th_percentile":2503.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"34","median_amount":46.83,"10th_percentile":45.72,"90th_percentile":73.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"237","median_amount":100.67,"10th_percentile":80.54,"90th_percentile":205.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":102.72,"10th_percentile":102.72,"90th_percentile":104.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"11","median_amount":2425.26,"10th_percentile":1744.87,"90th_percentile":4854.48,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":638.94,"10th_percentile":537.42,"90th_percentile":1451.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"24","median_amount":2745.12,"10th_percentile":1147.48,"90th_percentile":3590.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"182","median_amount":231.31,"10th_percentile":130.81,"90th_percentile":233.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":102.94,"10th_percentile":102.94,"90th_percentile":219.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"55","median_amount":229.05,"10th_percentile":182.25,"90th_percentile":351.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"22","median_amount":3453.55,"10th_percentile":1727.78,"90th_percentile":4371.28},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":13906.35,"10th_percentile":13906.35,"90th_percentile":13906.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"68","median_amount":232.46,"10th_percentile":154.92,"90th_percentile":355.31,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":102.94,"10th_percentile":102.94,"90th_percentile":189.57,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.25,"10th_percentile":182.25,"90th_percentile":183.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"33","median_amount":102.92,"10th_percentile":102.92,"90th_percentile":137.71,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"114","median_amount":152.13,"10th_percentile":148.83,"90th_percentile":154.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.78,"10th_percentile":183.04,"90th_percentile":366.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":4374.7,"10th_percentile":4374.7,"90th_percentile":4374.7},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4020.78,"10th_percentile":4020.78,"90th_percentile":4020.78},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"90","median_amount":2527.51,"10th_percentile":1228.4,"90th_percentile":3638.94},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"19","median_amount":102.94,"10th_percentile":102.94,"90th_percentile":205.88,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"30","median_amount":2733.44,"10th_percentile":1382.4,"90th_percentile":3378.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"63","median_amount":3321.0,"10th_percentile":1663.71,"90th_percentile":3782.0,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"22","median_amount":102.94,"10th_percentile":102.94,"90th_percentile":151.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"152","median_amount":228.82,"10th_percentile":183.04,"90th_percentile":347.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":233.48,"10th_percentile":232.46,"90th_percentile":423.09,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"30","median_amount":3664.0,"10th_percentile":1780.51,"90th_percentile":5649.99,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"22","median_amount":2793.9,"10th_percentile":2340.0,"90th_percentile":2822.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"235","median_amount":520.22,"10th_percentile":445.52,"90th_percentile":532.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":201.61,"10th_percentile":201.61,"90th_percentile":201.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"76","median_amount":608.97,"10th_percentile":505.57,"90th_percentile":668.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"202","median_amount":2617.56,"10th_percentile":1409.48,"90th_percentile":2674.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"78","median_amount":2478.14,"10th_percentile":1844.77,"90th_percentile":2972.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":2638.02,"10th_percentile":2638.02,"90th_percentile":2638.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":201.61,"10th_percentile":201.61,"90th_percentile":201.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"20","median_amount":3365.47,"10th_percentile":2692.38,"90th_percentile":3365.47},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":201.61,"10th_percentile":201.61,"90th_percentile":201.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":635.79,"10th_percentile":519.22,"90th_percentile":655.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":259.11,"10th_percentile":259.11,"90th_percentile":259.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"105","median_amount":522.02,"10th_percentile":376.41,"90th_percentile":654.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":201.61,"10th_percentile":189.57,"90th_percentile":201.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":415.22,"10th_percentile":415.22,"90th_percentile":415.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"16","median_amount":201.57,"10th_percentile":189.57,"90th_percentile":226.31,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"67","median_amount":273.01,"10th_percentile":267.1,"90th_percentile":322.72,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":415.22,"10th_percentile":415.22,"90th_percentile":415.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"72","median_amount":2490.13,"10th_percentile":1656.57,"90th_percentile":2827.8},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":201.61,"10th_percentile":201.61,"90th_percentile":201.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"19","median_amount":2323.96,"10th_percentile":1246.46,"90th_percentile":4354.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"45","median_amount":2952.98,"10th_percentile":1793.57,"90th_percentile":3014.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":201.61,"10th_percentile":201.61,"90th_percentile":201.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"187","median_amount":519.02,"10th_percentile":313.22,"90th_percentile":646.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":529.61,"10th_percentile":529.61,"90th_percentile":545.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3997.0,"10th_percentile":3997.0,"90th_percentile":3997.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":1161.93,"10th_percentile":1161.93,"90th_percentile":2713.96,"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":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"15","median_amount":2593.11,"10th_percentile":1732.12,"90th_percentile":5573.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"105","median_amount":171.95,"10th_percentile":168.51,"90th_percentile":415.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":434.18,"10th_percentile":137.74,"90th_percentile":602.13,"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":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":219.86,"10th_percentile":160.09,"90th_percentile":421.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"101","median_amount":2808.45,"10th_percentile":184.07,"90th_percentile":3527.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":773.96,"10th_percentile":773.96,"90th_percentile":773.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":137.74,"10th_percentile":137.74,"90th_percentile":137.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":2851.85,"10th_percentile":2413.85,"90th_percentile":7908.06},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":325.18,"10th_percentile":266.14,"90th_percentile":356.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.11,"10th_percentile":169.11,"90th_percentile":416.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":2759.27,"10th_percentile":2759.27,"90th_percentile":2759.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":174.3,"10th_percentile":100.0,"90th_percentile":521.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":137.74,"10th_percentile":137.74,"90th_percentile":137.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.59,"10th_percentile":159.59,"90th_percentile":159.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":137.71,"10th_percentile":23.87,"90th_percentile":339.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"29","median_amount":111.92,"10th_percentile":35.41,"90th_percentile":234.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":134.81,"10th_percentile":134.81,"90th_percentile":134.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2808.12,"10th_percentile":2808.12,"90th_percentile":2808.12},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"32","median_amount":2112.19,"10th_percentile":322.71,"90th_percentile":3838.93},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":137.74,"10th_percentile":23.88,"90th_percentile":162.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"13","median_amount":1227.24,"10th_percentile":331.52,"90th_percentile":3987.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"24","median_amount":2277.15,"10th_percentile":310.0,"90th_percentile":2679.0,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":275.48,"10th_percentile":100.88,"90th_percentile":604.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"84","median_amount":238.86,"10th_percentile":166.89,"90th_percentile":533.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":420.29,"10th_percentile":171.95,"90th_percentile":433.24,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3784.5,"10th_percentile":3784.5,"90th_percentile":3784.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":371.69,"10th_percentile":371.69,"90th_percentile":371.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"23","median_amount":4564.16,"10th_percentile":3524.25,"90th_percentile":7282.62,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"180","median_amount":342.06,"10th_percentile":142.06,"90th_percentile":613.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"16","median_amount":178.18,"10th_percentile":171.33,"90th_percentile":346.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":341.96,"10th_percentile":286.03,"90th_percentile":755.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"234","median_amount":3707.87,"10th_percentile":1622.0,"90th_percentile":4966.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"87","median_amount":3124.5,"10th_percentile":1637.0,"90th_percentile":4629.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"13","median_amount":173.13,"10th_percentile":173.13,"90th_percentile":346.26,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"16","median_amount":4044.97,"10th_percentile":2195.85,"90th_percentile":7508.25},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"68","median_amount":344.98,"10th_percentile":170.39,"90th_percentile":663.54,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":178.18,"10th_percentile":137.74,"90th_percentile":412.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":357.54,"10th_percentile":286.03,"90th_percentile":741.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"34","median_amount":215.23,"10th_percentile":135.67,"90th_percentile":365.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"80","median_amount":256.67,"10th_percentile":193.19,"90th_percentile":342.05,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":427.65,"10th_percentile":360.84,"90th_percentile":724.54,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4584.2,"10th_percentile":4584.2,"90th_percentile":4584.2},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"96","median_amount":3912.45,"10th_percentile":2916.92,"90th_percentile":6082.78},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"18","median_amount":173.13,"10th_percentile":173.13,"90th_percentile":286.49,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"32","median_amount":3775.93,"10th_percentile":2449.01,"90th_percentile":5757.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"70","median_amount":3571.0,"10th_percentile":1628.99,"90th_percentile":6276.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"24","median_amount":173.13,"10th_percentile":137.74,"90th_percentile":346.26,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"147","median_amount":342.27,"10th_percentile":193.73,"90th_percentile":647.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":355.59,"10th_percentile":344.96,"90th_percentile":905.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":6713.71,"10th_percentile":6713.71,"90th_percentile":6713.71,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":3558.24,"10th_percentile":2735.89,"90th_percentile":5475.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"27","median_amount":749.37,"10th_percentile":699.87,"90th_percentile":918.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":868.18,"10th_percentile":695.88,"90th_percentile":1022.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"31","median_amount":3105.69,"10th_percentile":2096.8,"90th_percentile":5221.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"20","median_amount":2866.88,"10th_percentile":2305.35,"90th_percentile":6835.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":5702.82,"10th_percentile":2877.96,"90th_percentile":6028.63},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":201.61,"10th_percentile":201.61,"90th_percentile":201.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":867.29,"10th_percentile":747.87,"90th_percentile":869.86,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":750.87,"10th_percentile":745.0,"90th_percentile":900.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":409.47,"10th_percentile":409.47,"90th_percentile":409.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":595.51,"10th_percentile":595.51,"90th_percentile":595.51,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":198.59,"10th_percentile":198.59,"90th_percentile":198.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":308.25,"10th_percentile":267.1,"90th_percentile":590.62,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":552.63,"10th_percentile":552.63,"90th_percentile":552.63,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"15","median_amount":2438.43,"10th_percentile":2017.32,"90th_percentile":5891.78},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":409.47,"10th_percentile":409.47,"90th_percentile":409.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":3363.17,"10th_percentile":2918.52,"90th_percentile":3794.26,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"13","median_amount":3425.64,"10th_percentile":2827.34,"90th_percentile":5401.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"31","median_amount":747.87,"10th_percentile":598.29,"90th_percentile":1111.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":776.52,"10th_percentile":763.13,"90th_percentile":865.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5614.35,"10th_percentile":5473.05,"90th_percentile":5664.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":1852.07,"10th_percentile":1675.5,"90th_percentile":7637.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":386.38,"10th_percentile":281.38,"90th_percentile":561.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":380.78,"10th_percentile":380.77,"90th_percentile":384.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"18","median_amount":842.06,"10th_percentile":673.65,"90th_percentile":2072.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":732.99,"10th_percentile":586.4,"90th_percentile":732.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":384.38,"10th_percentile":164.99,"90th_percentile":795.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":385.38,"10th_percentile":385.38,"90th_percentile":386.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":158.53,"10th_percentile":158.53,"90th_percentile":158.53,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":231.68,"10th_percentile":231.68,"90th_percentile":239.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":2119.6,"10th_percentile":2119.6,"90th_percentile":2119.6},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1884.16,"10th_percentile":1884.16,"90th_percentile":3950.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":2944.0,"10th_percentile":2944.0,"90th_percentile":2944.0,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":205.36,"10th_percentile":205.36,"90th_percentile":205.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":306.76,"10th_percentile":233.38,"90th_percentile":792.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":388.14,"10th_percentile":388.14,"90th_percentile":400.09,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":589.76,"10th_percentile":589.76,"90th_percentile":589.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":513.53,"10th_percentile":506.01,"90th_percentile":513.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":848.42,"10th_percentile":848.42,"90th_percentile":848.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1479.01,"10th_percentile":949.63,"90th_percentile":4732.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":874.7,"10th_percentile":874.7,"90th_percentile":1528.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":635.02,"10th_percentile":635.02,"90th_percentile":635.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":508.41,"10th_percentile":508.41,"90th_percentile":637.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":158.49,"10th_percentile":158.49,"90th_percentile":158.49,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":231.68,"10th_percentile":231.68,"90th_percentile":231.68,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":2968.53,"10th_percentile":2963.45,"90th_percentile":3007.53},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":192.18,"10th_percentile":192.18,"90th_percentile":192.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4362.02,"10th_percentile":3232.38,"90th_percentile":61950.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":2949.95,"10th_percentile":2949.95,"90th_percentile":2949.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":408.74,"10th_percentile":408.74,"90th_percentile":408.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":579.98,"10th_percentile":579.98,"90th_percentile":579.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":512.77,"10th_percentile":512.77,"90th_percentile":512.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":6148.56,"10th_percentile":6148.56,"90th_percentile":8949.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"67","median_amount":1241.77,"10th_percentile":990.77,"90th_percentile":1761.95,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":647.38,"10th_percentile":647.38,"90th_percentile":647.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":1321.5,"10th_percentile":1044.67,"90th_percentile":1957.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"36","median_amount":3712.14,"10th_percentile":3150.17,"90th_percentile":6416.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"18","median_amount":3487.24,"10th_percentile":2393.38,"90th_percentile":5874.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":457.81,"10th_percentile":457.81,"90th_percentile":457.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":7021.61,"10th_percentile":5231.34,"90th_percentile":8707.12},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":457.81,"10th_percentile":457.81,"90th_percentile":457.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1323.65,"10th_percentile":1064.27,"90th_percentile":1376.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":1240.37,"10th_percentile":934.28,"90th_percentile":1760.69,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":665.72,"10th_percentile":665.72,"90th_percentile":665.72,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1651.63,"10th_percentile":1651.63,"90th_percentile":1651.63,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":464.0,"10th_percentile":464.0,"90th_percentile":691.88,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":671.52,"10th_percentile":554.9,"90th_percentile":704.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"16","median_amount":5748.3,"10th_percentile":5439.3,"90th_percentile":8242.91},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":457.81,"10th_percentile":457.81,"90th_percentile":457.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":5609.1,"10th_percentile":3555.42,"90th_percentile":8168.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"14","median_amount":4872.9,"10th_percentile":4278.68,"90th_percentile":7690.97,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":509.83,"10th_percentile":509.83,"90th_percentile":665.72,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"75","median_amount":1239.98,"10th_percentile":988.61,"90th_percentile":1759.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1803.99,"10th_percentile":1260.99,"90th_percentile":2024.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":12524.37,"10th_percentile":12524.37,"90th_percentile":12524.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":5089.68,"10th_percentile":5089.68,"90th_percentile":5089.68,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"22","median_amount":1384.7,"10th_percentile":1209.48,"90th_percentile":4316.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":1385.2,"10th_percentile":1380.7,"90th_percentile":4317.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"15","median_amount":6188.72,"10th_percentile":5196.75,"90th_percentile":14919.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":6279.04,"10th_percentile":6031.04,"90th_percentile":11762.73,"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":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1384.7,"10th_percentile":1306.69,"90th_percentile":6573.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":7736.35,"10th_percentile":7736.35,"90th_percentile":7736.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1387.7,"10th_percentile":1380.7,"90th_percentile":3969.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":599.18,"10th_percentile":599.18,"90th_percentile":599.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":841.18,"10th_percentile":841.18,"90th_percentile":854.69,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1831.54,"10th_percentile":1831.54,"90th_percentile":1831.54},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":6826.84,"10th_percentile":6826.84,"90th_percentile":6826.84},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":7279.36,"10th_percentile":6413.68,"90th_percentile":7598.72,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":7019.02,"10th_percentile":6834.55,"90th_percentile":7019.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":599.32,"10th_percentile":599.32,"90th_percentile":599.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"36","median_amount":1380.71,"10th_percentile":1104.56,"90th_percentile":5311.88,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":4400.84,"10th_percentile":1408.88,"90th_percentile":7020.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":693.04,"10th_percentile":693.04,"90th_percentile":1744.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":812.74,"10th_percentile":812.74,"90th_percentile":812.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":468.51,"10th_percentile":468.51,"90th_percentile":468.51,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":693.04,"10th_percentile":693.04,"90th_percentile":693.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1263.21,"10th_percentile":1263.21,"90th_percentile":1263.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":831.57,"10th_percentile":831.57,"90th_percentile":831.57,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":146.0,"10th_percentile":146.0,"90th_percentile":438.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"60","median_amount":50.58,"10th_percentile":50.58,"90th_percentile":50.58,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":24.3,"10th_percentile":13.98,"90th_percentile":42.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":51.61,"10th_percentile":51.61,"90th_percentile":51.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"64","median_amount":54.88,"10th_percentile":54.88,"90th_percentile":200.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"21","median_amount":38.53,"10th_percentile":38.53,"90th_percentile":120.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":20.97,"10th_percentile":20.97,"90th_percentile":20.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":245.86,"10th_percentile":122.93,"90th_percentile":467.31},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.58,"10th_percentile":50.58,"90th_percentile":50.58,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":34.91,"10th_percentile":34.91,"90th_percentile":34.91,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":20.97,"10th_percentile":20.97,"90th_percentile":27.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"15","median_amount":20.33,"10th_percentile":20.33,"90th_percentile":50.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40.46,"10th_percentile":40.46,"90th_percentile":40.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"19","median_amount":90.96,"10th_percentile":90.96,"90th_percentile":279.72},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":405.92,"10th_percentile":93.44,"90th_percentile":972.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":208.34,"10th_percentile":107.86,"90th_percentile":746.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":48.19,"10th_percentile":20.97,"90th_percentile":54.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"37","median_amount":50.58,"10th_percentile":50.58,"90th_percentile":50.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":51.61,"10th_percentile":51.61,"90th_percentile":51.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":580.2,"10th_percentile":580.2,"90th_percentile":580.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"15","median_amount":162.21,"10th_percentile":162.21,"90th_percentile":162.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":82.92,"10th_percentile":82.92,"90th_percentile":82.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.52,"10th_percentile":165.52,"90th_percentile":165.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"15","median_amount":233.72,"10th_percentile":118.37,"90th_percentile":443.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":233.74,"10th_percentile":114.33,"90th_percentile":282.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":113.44,"10th_percentile":110.98,"90th_percentile":166.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.42,"10th_percentile":132.42,"90th_percentile":132.42,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":922.67,"10th_percentile":922.67,"90th_percentile":1143.83},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":93.41,"10th_percentile":93.41,"90th_percentile":93.41,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1144.96,"10th_percentile":976.64,"90th_percentile":1450.24,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1283.52,"10th_percentile":1283.52,"90th_percentile":1283.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":93.41,"10th_percentile":89.91,"90th_percentile":93.41,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"12","median_amount":162.21,"10th_percentile":162.21,"90th_percentile":162.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":1683.56,"10th_percentile":1683.56,"90th_percentile":1683.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":241.27,"10th_percentile":241.27,"90th_percentile":241.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6944.27,"10th_percentile":6944.27,"90th_percentile":6944.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1622.0,"10th_percentile":1065.55,"90th_percentile":9717.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":3072.0,"10th_percentile":3072.0,"90th_percentile":3072.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":301.31,"10th_percentile":301.31,"90th_percentile":301.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":169.41,"10th_percentile":169.41,"90th_percentile":169.41,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":89.1,"10th_percentile":89.1,"90th_percentile":170.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":2075.24,"10th_percentile":2075.24,"90th_percentile":2075.24},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":304.44,"10th_percentile":304.44,"90th_percentile":304.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":636.25,"10th_percentile":636.25,"90th_percentile":636.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":943.05,"10th_percentile":943.05,"90th_percentile":943.05,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":13598.35,"10th_percentile":13598.35,"90th_percentile":13598.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":70.62,"10th_percentile":70.62,"90th_percentile":70.62,"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":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":773.28,"10th_percentile":773.28,"90th_percentile":945.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1934.34,"10th_percentile":1934.34,"90th_percentile":1934.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":189.1,"10th_percentile":97.21,"90th_percentile":298.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":5922.28,"10th_percentile":5922.28,"90th_percentile":5922.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":317.84,"10th_percentile":317.84,"90th_percentile":317.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":390.0,"10th_percentile":390.0,"90th_percentile":892.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":197.98,"10th_percentile":22.64,"90th_percentile":330.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":718.12,"10th_percentile":718.12,"90th_percentile":718.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":224.59,"10th_percentile":84.36,"90th_percentile":384.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":718.31,"10th_percentile":718.31,"90th_percentile":718.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":67.64,"10th_percentile":65.76,"90th_percentile":267.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":84.49,"10th_percentile":84.49,"90th_percentile":84.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":240.45,"10th_percentile":173.9,"90th_percentile":2004.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"12","median_amount":1622.0,"10th_percentile":1317.0,"90th_percentile":1698.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":369.32,"10th_percentile":69.86,"90th_percentile":1462.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":96.57,"10th_percentile":96.57,"90th_percentile":96.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":84.49,"10th_percentile":84.49,"90th_percentile":84.49,"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":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2440.59,"10th_percentile":2440.59,"90th_percentile":2440.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1226.69,"10th_percentile":570.39,"90th_percentile":1843.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":95.89,"10th_percentile":95.89,"90th_percentile":136.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":90.32,"10th_percentile":29.2,"90th_percentile":120.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":634.87,"10th_percentile":484.79,"90th_percentile":1326.48},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":83.81,"10th_percentile":83.81,"90th_percentile":83.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":573.66,"10th_percentile":573.66,"90th_percentile":10118.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":83.81,"10th_percentile":83.81,"90th_percentile":83.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":746.92,"10th_percentile":173.91,"90th_percentile":812.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":152.96,"10th_percentile":152.96,"90th_percentile":152.96,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"19","median_amount":1378.89,"10th_percentile":968.1,"90th_percentile":2232.96,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":2195.18,"10th_percentile":2195.18,"90th_percentile":2214.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"28","median_amount":200.14,"10th_percentile":165.14,"90th_percentile":463.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":354.27,"10th_percentile":216.0,"90th_percentile":690.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":398.55,"10th_percentile":199.44,"90th_percentile":743.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"66","median_amount":484.22,"10th_percentile":264.7,"90th_percentile":3240.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"28","median_amount":1352.18,"10th_percentile":181.48,"90th_percentile":4676.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":299.53,"10th_percentile":299.53,"90th_percentile":299.53,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":243.12,"10th_percentile":199.44,"90th_percentile":728.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":200.25,"10th_percentile":159.42,"90th_percentile":709.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":240.02,"10th_percentile":128.95,"90th_percentile":248.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":293.95,"10th_percentile":203.2,"90th_percentile":375.87,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"37","median_amount":185.72,"10th_percentile":29.2,"90th_percentile":412.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"13","median_amount":2714.83,"10th_percentile":2308.58,"90th_percentile":4196.67},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":191.29,"10th_percentile":191.29,"90th_percentile":191.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":6023.64,"10th_percentile":6023.64,"90th_percentile":6023.64,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"15","median_amount":260.07,"10th_percentile":206.2,"90th_percentile":2311.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":313.61,"10th_percentile":313.61,"90th_percentile":313.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"51","median_amount":203.51,"10th_percentile":159.55,"90th_percentile":795.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":814.81,"10th_percentile":699.87,"90th_percentile":1131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3912.26,"10th_percentile":3912.26,"90th_percentile":3912.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2878.29,"10th_percentile":124.48,"90th_percentile":3750.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1046.78,"10th_percentile":1046.78,"90th_percentile":1046.78,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":231.47,"10th_percentile":231.47,"90th_percentile":231.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":235.82,"10th_percentile":235.82,"90th_percentile":294.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":397.49,"10th_percentile":294.77,"90th_percentile":416.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":255.57,"10th_percentile":254.78,"90th_percentile":555.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":295.78,"10th_percentile":295.78,"90th_percentile":417.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":504.27,"10th_percentile":504.27,"90th_percentile":504.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":573.39,"10th_percentile":573.39,"90th_percentile":573.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1465.29,"10th_percentile":1259.94,"90th_percentile":4072.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4072.0,"10th_percentile":4072.0,"90th_percentile":4072.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":3428.62,"10th_percentile":3428.62,"90th_percentile":3428.62},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":624.66,"10th_percentile":624.66,"90th_percentile":624.66,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":627.22,"10th_percentile":627.22,"90th_percentile":627.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":73.37,"10th_percentile":73.37,"90th_percentile":73.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":104.5,"10th_percentile":104.5,"90th_percentile":104.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1693.92,"10th_percentile":1383.53,"90th_percentile":2536.86},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1316.29,"10th_percentile":1316.29,"90th_percentile":1780.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1410.37,"10th_percentile":1410.37,"90th_percentile":1410.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":72.54,"10th_percentile":72.54,"90th_percentile":73.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":453.27,"10th_percentile":453.27,"90th_percentile":453.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":4644.86,"10th_percentile":4644.86,"90th_percentile":4938.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"47","median_amount":964.57,"10th_percentile":865.07,"90th_percentile":972.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":329.42,"10th_percentile":329.42,"90th_percentile":329.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":964.05,"10th_percentile":770.46,"90th_percentile":975.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"27","median_amount":4673.0,"10th_percentile":3738.4,"90th_percentile":4861.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":4673.0,"10th_percentile":4363.2,"90th_percentile":4848.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":5595.09,"10th_percentile":5595.09,"90th_percentile":6367.93},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":963.07,"10th_percentile":963.07,"90th_percentile":972.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":964.97,"10th_percentile":869.97,"90th_percentile":973.96,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":346.0,"10th_percentile":346.0,"90th_percentile":346.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":507.51,"10th_percentile":498.35,"90th_percentile":963.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":786.18,"10th_percentile":786.18,"90th_percentile":793.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"21","median_amount":4139.84,"10th_percentile":4139.84,"90th_percentile":4139.84},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":329.42,"10th_percentile":329.42,"90th_percentile":329.42,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":2976.96,"10th_percentile":2671.3,"90th_percentile":3873.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":4909.33,"10th_percentile":3927.46,"90th_percentile":5228.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":346.0,"10th_percentile":346.0,"90th_percentile":346.0,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"29","median_amount":963.57,"10th_percentile":770.46,"90th_percentile":972.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1012.99,"10th_percentile":1012.99,"90th_percentile":1012.99,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":185.75,"10th_percentile":148.6,"90th_percentile":222.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":724.68,"10th_percentile":724.68,"90th_percentile":724.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":74.7,"10th_percentile":74.7,"90th_percentile":104.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":187.9,"10th_percentile":143.59,"90th_percentile":300.64,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":281.15,"10th_percentile":281.15,"90th_percentile":281.15,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":89.76,"10th_percentile":57.38,"90th_percentile":313.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":224.91,"10th_percentile":224.91,"90th_percentile":224.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":56.23,"10th_percentile":56.23,"90th_percentile":57.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57.38,"10th_percentile":57.38,"90th_percentile":57.38,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":29.2,"10th_percentile":29.2,"90th_percentile":29.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":316.95,"10th_percentile":316.95,"90th_percentile":316.95,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.0,"10th_percentile":15.08,"90th_percentile":452.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":295.7,"10th_percentile":177.42,"90th_percentile":406.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":363.94,"10th_percentile":363.94,"90th_percentile":363.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"19","median_amount":122.72,"10th_percentile":122.02,"90th_percentile":122.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":28.09,"10th_percentile":19.35,"90th_percentile":111.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.82,"10th_percentile":122.82,"90th_percentile":122.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"59","median_amount":165.6,"10th_percentile":57.14,"90th_percentile":216.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"26","median_amount":116.24,"10th_percentile":31.22,"90th_percentile":379.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":114.26,"10th_percentile":114.26,"90th_percentile":114.26,"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":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":416.78,"10th_percentile":416.78,"90th_percentile":684.12},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":103.54,"10th_percentile":103.54,"90th_percentile":103.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":92.93,"10th_percentile":92.93,"90th_percentile":92.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":71.29,"10th_percentile":18.25,"90th_percentile":123.42,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"16","median_amount":31.63,"10th_percentile":28.87,"90th_percentile":380.66,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":930.6,"10th_percentile":930.6,"90th_percentile":930.6},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"18","median_amount":707.5,"10th_percentile":209.95,"90th_percentile":832.47},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":26.99,"10th_percentile":21.61,"90th_percentile":113.15,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":137.55,"10th_percentile":54.79,"90th_percentile":308.0,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"14","median_amount":835.58,"10th_percentile":367.18,"90th_percentile":1088.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":71.31,"10th_percentile":18.25,"90th_percentile":112.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"11","median_amount":122.92,"10th_percentile":122.0,"90th_percentile":263.11,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":241.91,"10th_percentile":241.91,"90th_percentile":241.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1915.49,"10th_percentile":1915.49,"90th_percentile":1915.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8.44,"10th_percentile":8.44,"90th_percentile":8.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1318.06,"10th_percentile":1318.06,"90th_percentile":1318.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"33","median_amount":594.23,"10th_percentile":154.89,"90th_percentile":959.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":204.93,"10th_percentile":204.93,"90th_percentile":204.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":839.23,"10th_percentile":357.57,"90th_percentile":1198.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"42","median_amount":1884.0,"10th_percentile":374.0,"90th_percentile":3246.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"20","median_amount":1408.0,"10th_percentile":704.0,"90th_percentile":2816.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":359.37,"10th_percentile":119.79,"90th_percentile":958.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":718.74,"10th_percentile":246.1,"90th_percentile":1138.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":386.46,"10th_percentile":386.46,"90th_percentile":386.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":688.66,"10th_percentile":688.66,"90th_percentile":688.66,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"11","median_amount":1525.35,"10th_percentile":391.24,"90th_percentile":2022.25},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":957.44,"10th_percentile":957.44,"90th_percentile":1282.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"14","median_amount":2420.31,"10th_percentile":980.25,"90th_percentile":2821.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":64.43,"10th_percentile":64.43,"90th_percentile":64.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"57","median_amount":614.3,"10th_percentile":245.72,"90th_percentile":953.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":877.52,"10th_percentile":376.08,"90th_percentile":1094.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":1613.55,"10th_percentile":1613.55,"90th_percentile":1613.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":621.44,"10th_percentile":620.94,"90th_percentile":1312.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1761.46,"10th_percentile":805.1,"90th_percentile":4589.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":1390.66,"10th_percentile":1390.66,"90th_percentile":2952.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1513.1,"10th_percentile":1513.1,"90th_percentile":1781.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1214.15,"10th_percentile":1214.15,"90th_percentile":1214.15,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1791.3,"10th_percentile":1791.3,"90th_percentile":1791.3},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":6122.16,"10th_percentile":5274.29,"90th_percentile":6368.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":627.34,"10th_percentile":627.34,"90th_percentile":1204.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":351.14,"10th_percentile":351.14,"90th_percentile":351.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":546.83,"10th_percentile":546.83,"90th_percentile":546.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":77.0,"10th_percentile":77.0,"90th_percentile":77.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":1479.8,"10th_percentile":648.0,"90th_percentile":1764.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":1415.8,"10th_percentile":1176.0,"90th_percentile":3135.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":112.91,"10th_percentile":105.14,"90th_percentile":248.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":295.55,"10th_percentile":295.55,"90th_percentile":295.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":163.12,"10th_percentile":112.88,"90th_percentile":219.58,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":99.7,"10th_percentile":97.54,"90th_percentile":133.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1168.31,"10th_percentile":689.72,"90th_percentile":2250.3},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":90.36,"10th_percentile":83.87,"90th_percentile":201.51,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1315.17,"10th_percentile":1072.86,"90th_percentile":1318.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":172.35,"10th_percentile":172.35,"90th_percentile":172.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":262.11,"10th_percentile":262.11,"90th_percentile":262.11,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2433.47,"10th_percentile":2433.47,"90th_percentile":2433.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.7,"10th_percentile":144.7,"90th_percentile":144.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":252.25,"10th_percentile":252.25,"90th_percentile":295.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":450.96,"10th_percentile":450.96,"90th_percentile":450.96,"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":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":257.73,"10th_percentile":257.73,"90th_percentile":257.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":134.79,"10th_percentile":134.79,"90th_percentile":134.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":152.49,"10th_percentile":152.49,"90th_percentile":152.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":177.07,"10th_percentile":177.07,"90th_percentile":177.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":17743.0,"10th_percentile":17743.0,"90th_percentile":17743.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Covid-19 Vaccine Administration","code_information":[{"code":"9398","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":319.71,"10th_percentile":319.71,"90th_percentile":319.71,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":81.36,"10th_percentile":81.36,"90th_percentile":94.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":193.73,"10th_percentile":193.73,"90th_percentile":193.73,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":2539.69,"10th_percentile":2539.69,"90th_percentile":2539.69,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1429.02,"10th_percentile":1429.02,"90th_percentile":1429.02},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.91,"10th_percentile":122.91,"90th_percentile":122.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"160","median_amount":74.34,"10th_percentile":27.68,"90th_percentile":257.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"972","median_amount":26.04,"10th_percentile":13.11,"90th_percentile":76.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"232","median_amount":32.39,"10th_percentile":8.94,"90th_percentile":160.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"249","median_amount":33.73,"10th_percentile":11.02,"90th_percentile":99.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1587","median_amount":50.27,"10th_percentile":16.46,"90th_percentile":194.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"984","median_amount":38.47,"10th_percentile":12.91,"90th_percentile":136.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":254.15,"10th_percentile":13.4,"90th_percentile":440.93,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"76","median_amount":29.0,"10th_percentile":8.74,"90th_percentile":210.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"156","median_amount":252.6,"10th_percentile":26.52,"90th_percentile":854.64},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8.34,"10th_percentile":8.34,"90th_percentile":35.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"179","median_amount":27.37,"10th_percentile":13.31,"90th_percentile":74.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":212.51,"10th_percentile":212.51,"90th_percentile":212.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"276","median_amount":28.96,"10th_percentile":11.02,"90th_percentile":84.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"85","median_amount":20.77,"10th_percentile":11.53,"90th_percentile":153.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25.23,"10th_percentile":13.75,"90th_percentile":43.78,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"285","median_amount":29.34,"10th_percentile":9.14,"90th_percentile":106.24,"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":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"553","median_amount":11.84,"10th_percentile":6.11,"90th_percentile":84.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":32.38,"10th_percentile":17.82,"90th_percentile":225.54,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":25.0,"10th_percentile":25.0,"90th_percentile":25.0},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":284.43,"10th_percentile":75.6,"90th_percentile":882.0},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":165.66,"10th_percentile":165.66,"90th_percentile":165.66},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"830","median_amount":294.05,"10th_percentile":56.69,"90th_percentile":705.23},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"188","median_amount":31.44,"10th_percentile":4.45,"90th_percentile":142.63,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"292","median_amount":59.85,"10th_percentile":19.67,"90th_percentile":176.42,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"494","median_amount":271.88,"10th_percentile":56.89,"90th_percentile":788.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"158","median_amount":35.91,"10th_percentile":10.91,"90th_percentile":175.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1228","median_amount":28.12,"10th_percentile":13.12,"90th_percentile":84.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59.3,"10th_percentile":24.02,"90th_percentile":70.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":345.8,"10th_percentile":221.35,"90th_percentile":1209.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"24","median_amount":242.84,"10th_percentile":100.0,"90th_percentile":621.0,"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."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"40","median_amount":696.88,"10th_percentile":286.52,"90th_percentile":1686.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"332","median_amount":172.82,"10th_percentile":66.39,"90th_percentile":354.77,"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":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"1 through 10","median_amount":279.93,"10th_percentile":279.93,"90th_percentile":279.93,"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":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"134","median_amount":130.88,"10th_percentile":62.76,"90th_percentile":282.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"146","median_amount":141.69,"10th_percentile":70.0,"90th_percentile":304.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"519","median_amount":972.0,"10th_percentile":399.0,"90th_percentile":2435.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"575","median_amount":704.0,"10th_percentile":316.8,"90th_percentile":1460.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":487.0,"10th_percentile":487.0,"90th_percentile":487.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"70","median_amount":210.57,"10th_percentile":94.14,"90th_percentile":426.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"61","median_amount":671.92,"10th_percentile":309.46,"90th_percentile":1319.52},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"37","median_amount":264.87,"10th_percentile":118.32,"90th_percentile":558.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"101","median_amount":147.3,"10th_percentile":68.55,"90th_percentile":344.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"169","median_amount":162.16,"10th_percentile":54.03,"90th_percentile":422.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"27","median_amount":130.05,"10th_percentile":94.04,"90th_percentile":282.42,"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":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":96.51,"10th_percentile":96.51,"90th_percentile":257.0,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":183.69,"10th_percentile":183.69,"90th_percentile":207.48,"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":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"115","median_amount":182.33,"10th_percentile":89.88,"90th_percentile":407.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"140","median_amount":146.25,"10th_percentile":46.3,"90th_percentile":430.86,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":93.35,"10th_percentile":70.97,"90th_percentile":323.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1260.74,"10th_percentile":1260.74,"90th_percentile":1260.74},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"406","median_amount":660.45,"10th_percentile":278.1,"90th_percentile":1956.85},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"96","median_amount":149.11,"10th_percentile":59.16,"90th_percentile":236.64,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"114","median_amount":786.86,"10th_percentile":305.28,"90th_percentile":2499.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"307","median_amount":714.37,"10th_percentile":290.0,"90th_percentile":2276.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"77","median_amount":158.78,"10th_percentile":59.16,"90th_percentile":317.88,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"590","median_amount":144.92,"10th_percentile":67.43,"90th_percentile":325.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"86","median_amount":208.01,"10th_percentile":99.74,"90th_percentile":423.66,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"287","median_amount":1164.55,"10th_percentile":475.4,"90th_percentile":2983.95,"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":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":900.0,"10th_percentile":541.84,"90th_percentile":1381.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"42","median_amount":807.35,"10th_percentile":652.34,"90th_percentile":807.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"197","median_amount":105.67,"10th_percentile":105.67,"90th_percentile":108.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30.17,"10th_percentile":30.17,"90th_percentile":31.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"70","median_amount":105.67,"10th_percentile":105.67,"90th_percentile":108.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"380","median_amount":632.0,"10th_percentile":572.6,"90th_percentile":646.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"363","median_amount":596.0,"10th_percentile":540.2,"90th_percentile":612.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":632.0,"10th_percentile":540.2,"90th_percentile":646.0,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30.17,"10th_percentile":30.17,"90th_percentile":30.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"20","median_amount":972.51,"10th_percentile":972.51,"90th_percentile":972.51},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":31.32,"10th_percentile":31.32,"90th_percentile":31.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":164.69,"10th_percentile":164.04,"90th_percentile":168.86,"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":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"1 through 10","median_amount":937.86,"10th_percentile":937.86,"90th_percentile":937.86},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"1 through 10","median_amount":658.81,"10th_percentile":658.81,"90th_percentile":658.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"68","median_amount":105.67,"10th_percentile":105.67,"90th_percentile":108.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30.17,"10th_percentile":30.17,"90th_percentile":31.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.69,"10th_percentile":164.69,"90th_percentile":164.69,"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":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"32","median_amount":30.17,"10th_percentile":30.17,"90th_percentile":31.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"25","median_amount":45.16,"10th_percentile":44.19,"90th_percentile":45.99,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86.26,"10th_percentile":86.26,"90th_percentile":110.97,"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":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":807.35,"10th_percentile":807.35,"90th_percentile":1039.5},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"207","median_amount":719.57,"10th_percentile":581.2,"90th_percentile":719.57},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"22","median_amount":30.17,"10th_percentile":30.17,"90th_percentile":31.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"64","median_amount":739.2,"10th_percentile":591.36,"90th_percentile":739.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"109","median_amount":482.0,"10th_percentile":470.0,"90th_percentile":482.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"15","median_amount":30.17,"10th_percentile":30.17,"90th_percentile":31.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"180","median_amount":105.68,"10th_percentile":105.67,"90th_percentile":108.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":107.83,"10th_percentile":107.83,"90th_percentile":110.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"1 through 10","median_amount":630.17,"10th_percentile":630.17,"90th_percentile":784.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":147.38,"10th_percentile":147.38,"90th_percentile":176.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.02,"10th_percentile":169.02,"90th_percentile":169.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":116.9,"10th_percentile":116.9,"90th_percentile":116.9,"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":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":1383.07,"10th_percentile":1383.07,"90th_percentile":1383.07},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":1958.56,"10th_percentile":1958.56,"90th_percentile":1958.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.22,"10th_percentile":144.22,"90th_percentile":144.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":246.94,"10th_percentile":246.94,"90th_percentile":246.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"1 through 10","median_amount":592.06,"10th_percentile":592.06,"90th_percentile":1281.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"25","median_amount":93.65,"10th_percentile":93.65,"90th_percentile":115.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14.07,"10th_percentile":14.07,"90th_percentile":14.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":101.73,"10th_percentile":92.94,"90th_percentile":121.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"37","median_amount":536.04,"10th_percentile":453.8,"90th_percentile":723.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"21","median_amount":456.5,"10th_percentile":428.6,"90th_percentile":681.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":1543.39,"10th_percentile":1543.39,"90th_percentile":1543.39},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30.17,"10th_percentile":30.17,"90th_percentile":30.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":162.07,"10th_percentile":162.07,"90th_percentile":184.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":99.69,"10th_percentile":99.69,"90th_percentile":99.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":31.32,"10th_percentile":31.32,"90th_percentile":31.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":45.16,"10th_percentile":45.16,"90th_percentile":45.99,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":527.69,"10th_percentile":527.69,"90th_percentile":922.11},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30.17,"10th_percentile":30.17,"90th_percentile":31.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":542.08,"10th_percentile":542.08,"90th_percentile":542.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"12","median_amount":470.0,"10th_percentile":470.0,"90th_percentile":482.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"21","median_amount":115.5,"10th_percentile":93.65,"90th_percentile":122.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":245.57,"10th_percentile":226.02,"90th_percentile":245.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":989.05,"10th_percentile":989.05,"90th_percentile":989.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":49.68,"10th_percentile":49.68,"90th_percentile":49.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"1 through 10","median_amount":721.7,"10th_percentile":721.7,"90th_percentile":721.7},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":28.16,"10th_percentile":28.16,"90th_percentile":28.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"1 through 10","median_amount":102.34,"10th_percentile":102.34,"90th_percentile":102.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"1 through 10","median_amount":23.4,"10th_percentile":23.4,"90th_percentile":23.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"1 through 10","median_amount":27.15,"10th_percentile":27.15,"90th_percentile":27.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.86,"10th_percentile":55.86,"90th_percentile":55.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":178.18,"10th_percentile":178.18,"90th_percentile":178.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":60.0,"10th_percentile":60.0,"90th_percentile":60.0,"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":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":76.84,"10th_percentile":76.84,"90th_percentile":76.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Implant DME","code_information":[{"code":"N906","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 69.9] [Observation (%BC): 69.9] [Emergency Department (%BC): 69.9] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 69.9] [Physical Therapy (%BC): 69.9] [Respiratory Services/Therapy  (%BC): 69.9] [Speech Therapy (%BC): 69.9] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 34.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other OP (%BC): 38.68]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [Mental Health ($): 235] [Mental Health-Intensive ($): 266] [Mental Health-Partial Hospitalization ($): 266] [OP ECT Mental Health ($): 667] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 9837] [Cardiac Cath (%BC): 62] [Lithotripsy (%BC): 62] [PTCA (%BC): 62] [Observation ($): 10478] [Critical Care ($): 5239] [Urgent Care ($): 303] [Cardiac Rehabilitation Therapy ($): 352] [Electrophysiologic Ablation (%BC): 62] [Electrophysiology and Mapping Studies (%BC): 62] [Sleep Studies ($): 4848] [CT Scan OP ($): 2812] [MRI OP ($): 4217] [Mammography-Diagnostic ($): 317] [Mammography-Screening ($): 317] [Positron Emission Tomography ($): 4920] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 879] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 352] [Physical Therapy ($): 352] [Speech Therapy ($): 352] [Mental Health ($): 212] [Mental Health-Intensive ($): 247] [Mental Health-Partial Hospitalization ($): 247] [OP ECT Mental Health ($): 666] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13180] [Cardiac Cath (%BC): 66] [Lithotripsy (%BC): 66] [PTCA (%BC): 66] [Observation ($): 10370] [Critical Care ($): 5185] [Urgent Care ($): 300] [Cardiac Rehabilitation Therapy ($): 487] [Electrophysiologic Ablation (%BC): 66] [Electrophysiology and Mapping Studies (%BC): 66] [Sleep Studies ($): 4673] [CT Scan OP ($): 3339] [MRI OP ($): 4673] [Mammography-Diagnostic ($): 335] [Mammography-Screening ($): 335] [Positron Emission Tomography ($): 5006] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 869] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 66] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 66] [Occupational Therapy ($): 487] [Physical Therapy ($): 487] [Speech Therapy ($): 487] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5572] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30885] [Insertion of Permanent Pacemaker ($): 26415] [Joint Replacement-Full/Partial ($): 19736] [PTCA w/ Drug Eluting Stent ($): 28729] [PTCA w/non Drug Eluting Stent ($): 28466] [PTCA w/out stent ($): 23733] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 12713] [ED Level 1--99281 ($): 296] [ED Level 2--99282 ($): 797] [ED Level 3--99283 ($): 1335] [ED Level 4--99284 ($): 2769] [ED Level 5--99285 ($): 5476] [Critical Care ($): 7288] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 182] [Cardiac Stress Test ($): 868] [Cardiology ($): 586] [Echocardiology ($): 2341] [EKG/ECG ($): 223] [Electrophysiology ($): 18705] [Electrophysiology Ablation ($): 60022] [Electrophysiology and Mapping Studies ($): 51239] [Holter Monitor/Telemetry ($): 1274] [Peripheral Vascular Lab ($): 1238] [EEG ($): 915] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 351] [Sleep Studies-Attended ($): 4533] [Sleep Studies-Unattended ($): 536] [Chemotherapy ($): 662] [Nuclear Medicine ($): 3327] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2225] [MRI OP ($): 3362] [Imaging Services ($): 421] [Mammography-Diagnostic ($): 378] [Mammography-Screening ($): 378] [Positron Emission Tomography ($): 5864] [Radiology ($): 288] [Ultrasound Imaging ($): 580] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 778] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 360] [Physical Therapy ($): 360] [Resp. Services/Therapy ($): 263] [Speech Therapy ($): 278] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 347] [Pulmonary Function ($): 1146] [Pulmonary Rehabilitation ($): 131] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"1 through 10","median_amount":242.55,"10th_percentile":242.55,"90th_percentile":242.55},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":62.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 64] [Observation (%BC): 64] [Emergency Department (%BC): 64] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 64] [Physical Therapy (%BC): 64] [Respiratory Services/Therapy  (%BC): 64] [Speech Therapy (%BC): 64] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 73.88] [Stereotactic Radiosurgery (%BC): 73.88] [Stereotactic Radiosurgery-Fractionated (%BC): 73.88] [Observation (%BC): 73.88] [Emergency Department (%BC): 73.88] [Urgent Care (%BC): 73.88] [Cardiac Rehabilitation Therapy (%BC): 73.88] [Cardiac Stress Test (%BC): 73.88] [Cardiology (%BC): 73.88] [Echocardiology (%BC): 73.88] [EKG/ECG  (%BC): 73.88] [Holter Monitor/Telemetry (%BC): 73.88] [Peripheral Vascular Lab (%BC): 73.88] [EEG (%BC): 73.88] [EMG (%BC): 73.88] [MEG (%BC): 73.88] [Neuropsychological Testing and Biofeedback (%BC): 73.88] [Sleep Studies (%BC): 73.88] [Chemotherapy (%BC): 73.88] [Nuclear Medicine ($): 2574] [Oncology (%BC): 73.88] [Radiation Therapy  (%BC): 73.88] [CT Scan OP ($): 2679] [MRI OP ($): 3782] [Imaging Services ($): 420] [Mammography-Diagnostic ($): 482] [Mammography-Screening ($): 482] [Positron Emission Tomography ($): 6330] [Radiology ($): 310] [Ultrasound Imaging ($): 526] [Laboratory (%BC): 73.88] [Pathology (%BC): 73.88] [Hemodialysis (%BC): 73.88] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 73.88] [Occupational Therapy (%BC): 73.88] [Physical Therapy (%BC): 73.88] [Respiratory Services/Therapy  (%BC): 73.88] [Speech Therapy (%BC): 73.88] [OP High Cost Drugs ($): FEE SCHEDULE] [Ambulance--Air  (%BC): 73.88] [Ambulance--Land  (%BC): 73.88] [Hyperbarics (%BC): 73.88] [IV Therapy (%BC): 73.88] [Pulmonary Function (%BC): 73.88] [Pulmonary Rehabilitation (%BC): 73.88]","count":"1 through 10","median_amount":114.88,"10th_percentile":114.88,"90th_percentile":114.88,"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":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Ambulance--Air ($): 2300] [Ambulance--Land ($): 350] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 67.90] [Observation (%BC): 67.90] [Emergency Department (%BC): 67.90] [Occupational Therapy (%BC): 67.90] [Physical Therapy (%BC): 67.90] [Respiratory Services/Therapy  (%BC): 67.90] [Speech Therapy (%BC): 67.90] [OP High Cost Drugs ($): FEE SCHEDULE] [All Other OP (%BC): 67.90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12069.13,"10th_percentile":12069.13,"90th_percentile":12069.13,"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":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Or Device Replacement With Mcc","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Or Device Replacement Without Mcc","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures With Mcc","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures Without Mcc","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Or Knee Procedures With Principal Diagnosis Of Periprosthetic Joint Infection With Mcc Or Insert","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Or Knee Procedures With Principal Diagnosis Of Periprosthetic Joint Infection Without Mcc","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Prosthesis","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical With Mcc","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical With Cc","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical Without Cc/Mcc","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy With Mcc","code_information":[{"code":"731","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy With Cc","code_information":[{"code":"732","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"733","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medicaid Managed Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"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 Commercial Plans","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs ($): FEE SCHEDULE] [All Other IP (%BC): 69.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Auto","plan_name":"Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 4.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1201] [Psych-Per Diem: 1201] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred / Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.25 | Excess % of Charge: 56] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14056 Days: 4 Additional Days: 2134] [Normal vag. Del. 4 day stay-Case Rate: 8433 Days: 4 Additional Days: 2134] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2804] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Alcohol/ Chemical Dependency-Per Diem: 1230] [Psych-Per Diem: 1230] [Rehab-Per Diem: 2134] [All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.62 | Excess % of Charge: 76] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16691 Days: 4 Additional Days: 2136] [Normal vag. Del. 4 day stay-Case Rate: 9346 Days: 4 Additional Days: 2136] [Normal Newborn-Per Diem: 1335] [Lower Level Neonate-Per Diem: 2805] [Higher Level Neonate-Per Diem: 4807] [Severe Level Neonate-per diem: 4807] [Rehab-Per Diem: 2136] [All Other IP (%BC): 66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Median(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 5794] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 13824 Days: 4 Additional Days: 1448] [Normal vag. Del. 2 day stay-Case Rate: 7834 Days: 2 Additional Days: 1448] [Normal Newborn-Per Diem: 1183] [Lower Level Neonate-Per Diem: 1436] [Higher Level Neonate-Per Diem: 1770] [Severe Level Neonate-per diem: 2172] [Psych-Per Diem: 1529] [Rehab-Per Diem: 2011] [SNF-(% BC): 80] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":84.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Heath Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Employers Coalition on Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":81.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":70.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICARE","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"INCULSA","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"HealthEOS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS Primary Network All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 2 | Excess % of Charge: 83] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"QUARTZ","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6285] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19336 Days: 4 Additional Days: 2074] [Normal vag. Del. 2 day stay-Case Rate: 10925 Days: 2 Additional Days: 2074] [Normal Newborn-Per Diem: 1173] [Lower Level Neonate-Per Diem: 1362] [Higher Level Neonate-Per Diem: 1844] [Severe Level Neonate-per diem: 3600] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 98661 | Total % of Charge: 68.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17070 Days: 4 Additional Days: 2286] [Normal vag. Del. 2 day stay-Case Rate: 10501 Days: 2 Additional Days: 2286] [Normal Newborn-Per Diem: 1629] [Lower Level Neonate-Per Diem: 1794] [Higher Level Neonate-Per Diem: 1900] [Severe Level Neonate-per diem: 1900]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Care Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"OPTUM VACCN Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":67.9,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rem mlt day uroflow setup","code_information":[{"code":"0811T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.32,"maximum":129.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.32,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr impl ivc snr set-up","code_information":[{"code":"0982T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.32,"maximum":129.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.32,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr s-scl eeg sys 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disch","code_information":[{"code":"99495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.32,"maximum":129.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.32,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 7 day disch","code_information":[{"code":"99496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.32,"maximum":129.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.32,"additional_payer_notes":"APC"}]}]},{"description":"Periodic oral evaluation","code_information":[{"code":"D0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.32,"maximum":129.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare 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